Skip to main content

General Principles and Indications

  • Chapter
  • First Online:
Lymphedema
  • 1882 Accesses

Abstract

Chronic lymphedema continues to be a challenge in both diagnosis and management. The diagnostic dilemma remains about how to best define detailed anatomy and lymphatic function, Whereas the problem with treatment remains our inability to cure chronic lymphedema. Still, both evaluation and treatment have greatly improved in recent years. Progress in genetics, imaging studies, physical therapy, and microsurgical techniques have sparked interest in chronic lymphedema, a disease long considered to be the stepchild of medicine. This textbook is testimony to the increasing interest in the investigation and treatment of lymphatic disorders.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 159.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Jacobson JH 2nd. Founder’s Lecture in plastic surgery. Ann Plast Surg. 2006;56(5):471-474.

    Article  PubMed  CAS  Google Scholar 

  2. Edwards JM, Kinmonth JB. Lymphovenous shunts in man. Br Med J. 1969;4(5683):579-581.

    Article  PubMed  CAS  Google Scholar 

  3. Gilbert A, O’Brien BM, Vorrath JW, Sykes PJ. Lymphaticovenous anastomosis by microvascular technique. Br J Plast Surg. 1976;29(4):355-360.

    Article  PubMed  CAS  Google Scholar 

  4. O’Brien BM. Microlymphaticovenous surgery for obstructive lymphoedema. Aust NZ J Surg. 1977;47(3):284-291.

    Article  Google Scholar 

  5. O’Brien BM. The role of microsurgery in modern surgery. Ann Plast Surg. 1990;24(3):258-267.

    Article  PubMed  Google Scholar 

  6. Gloviczki P, Le Floch P, Hidden G. Lymphatico-venous experimental anastomosis (author’s transl). J Chir. 1979;116(6-7):437-443.

    CAS  Google Scholar 

  7. Gloviczki P, Hollier LH, Nora FE, Kaye MP. The natural history of microsurgical lymphovenous anastomoses: an experimental study. J Vasc Surg. 1986;4(2):148-156.

    Article  PubMed  CAS  Google Scholar 

  8. Gloviczki P, Fisher J, Hollier LH, Pairolero PC, Schirger A, Wahner HW. Microsurgical lymphovenous anastomosis for treatment of lymphedema: a critical review. J Vasc Surg. 1988;7(5):647-652.

    Article  PubMed  CAS  Google Scholar 

  9. Laine JB, Howard JM. Experimental lymphatico-venous anastomosis. Surg Forum. 1963;14:111-112.

    PubMed  CAS  Google Scholar 

  10. Degni M. New technique of lymphatic-venous anastomosis (buried type) for the treatment of lymphedema. Vasa. 1974;3(4):479-483.

    PubMed  CAS  Google Scholar 

  11. Nieuborg L, Hoynck van Papendrecht A, Olthuis GA, van Dongen RJ. Treatment of secondary lymphedema with lymphatico-venous anastomosis. Ned Tijdschr Geneeskd. 1981;125(33):1330-1333.

    PubMed  CAS  Google Scholar 

  12. Huang GK, Hu RQ, Liu ZZ, Shen YL, Lan TD, Pan GP. Microlymphaticovenous anastomosis in the treatment of lower limb obstructive lymphedema: analysis of 91 cases. Plast Reconstr Surg. 1985;76(5):671-685.

    Article  PubMed  CAS  Google Scholar 

  13. Campisi C. A rational approach to the management of lymphedema. Lymphology. 1991;24(2):48-53.

    PubMed  CAS  Google Scholar 

  14. Campisi C. Lymphatic microsurgery: a potent weapon in the war on lymphedema. Lymphology. 1995;28(3):110-112.

    PubMed  CAS  Google Scholar 

  15. Campisi C. Lymphoedema: modern diagnostic and therapeutic aspects. Int Angiol. 1999;18(1):14-24.

    PubMed  CAS  Google Scholar 

  16. Campisi C, Boccardo F. Microsurgical techniques for lymphedema treatment: derivative ­lymphatic-venous microsurgery. World J Surg. 2004;28(6):609-613.

    Article  PubMed  Google Scholar 

  17. Campisi C, Davini D, Bellini C, et al. Lymphatic microsurgery for the treatment of lymphedema. Microsurgery. 2006;26(1):65-69.

    Article  PubMed  CAS  Google Scholar 

  18. Campisi C, Bellini C, Campisi C, Accogli S, Bonioli E, Boccardo F. Microsurgery for ­lymphedema: clinical research and long-term results. Microsurgery. 2010;30(4):256-260.

    PubMed  Google Scholar 

  19. Koshima I, Yamamoto T, Narushima M, Mihara M, Iida T. Perforator flaps and supermicrosurgery. Clin Plast Surg. 2010;37(4):683-689. vii-iii.

    Article  PubMed  Google Scholar 

  20. Lee BB. Contemporary issues in management of chronic lymphedema: personal reflection on an experience with 1065 patients. Lymphology. 2005;38(1):28-31.

    PubMed  CAS  Google Scholar 

  21. Lee BB, Kim DI, Whang JH, Lee KW. Contemporary management of chronic lymphedema—personal experiences. Lymphology. 2002;35:450-455.

    Google Scholar 

  22. Nagase T, Gonda K, Inoue K, et al. Treatment of lymphedema with lymphaticovenular anastomoses. Int J Clin Oncol. 2005;10(5):304-310.

    Article  PubMed  Google Scholar 

  23. Melduni RM, Oh JK, Bunch TJ, Sinak LJ, Gloviczki P. Reconstruction of occluded thoracic duct for treatment of chylopericardium: a novel surgical therapy. J Vasc Surg. 2008;48(6):1600-1602.

    Article  PubMed  Google Scholar 

  24. Demirtas Y, Ozturk N, Yapici O, Topalan M. Comparison of primary and secondary lower-extremity lymphedema treated with supermicrosurgical lymphaticovenous anastomosis and lymphaticovenous implantation. J Reconstr Microsurg. 2010;26(2):137-143.

    Article  PubMed  Google Scholar 

  25. Demirtas Y, Ozturk N, Yapici O, Topalan M. Supermicrosurgical lymphaticovenular anastomosis and lymphaticovenous implantation for treatment of unilateral lower extremity lymphedema. Microsurgery. 2009;29(8):609-618.

    Article  PubMed  Google Scholar 

  26. Narushima M, Mihara M, Yamamoto Y, Iida T, Koshima I, Mundinger GS. The intravascular stenting method for treatment of extremity lymphedema with multiconfiguration lymphaticovenous anastomoses. Plast Reconstr Surg. 2010;125(3):935-943.

    Article  PubMed  CAS  Google Scholar 

  27. Nielubowicz J, Olszewski W. Surgical lymphaticovenous shunts in patients with secondary lymphoedema. Br J Surg. 1968;55(6):440-442.

    Article  PubMed  CAS  Google Scholar 

  28. Jamal S. Lymphovenous anastomosis in filarial lymphedema. Lymphology. 1981;14(2):64-68.

    PubMed  CAS  Google Scholar 

  29. Jamal S. Lymph nodo-venous shunt in the treatment of protein losing enteropathy and lymphedema of leg and scrotum. Lymphology. 2007;40(1):47-48.

    PubMed  CAS  Google Scholar 

  30. Olszewski WL. The treatment of lymphedema of the extremities with microsurgical lympho-venous anastomoses. Int Angiol. 1988;7(4):312-321.

    PubMed  CAS  Google Scholar 

  31. Baumeister RG, Seifert J. Microsurgical lymphvessel-transplantation for the treatment of lymphedema: experimental and first clinical experiences. Lymphology. 1981;14(2):90.

    PubMed  CAS  Google Scholar 

  32. Baumeister RG, Frick A. The microsurgical lymph vessel transplantation. Handchir Mikrochir Plast Chir. 2003;35(4):202-209.

    Article  PubMed  CAS  Google Scholar 

  33. Baumeister RG, Siuda S. Treatment of lymphedemas by microsurgical lymphatic grafting: What is proved? Plast Reconstr Surg. 1990;85(1):64-74; discussion 5-6.

    Article  PubMed  CAS  Google Scholar 

  34. Baumeister R. Lymphedema: surgical treatment. In: Cronenwett JL, Johnston KW, eds. Rutherford’s Vascular Surgery. 7th ed. Philadelphia: Saunders; 2010:1029-1043.

    Google Scholar 

  35. Maegawa J, Mikami T, Yamamoto Y, Hirotomi K, Kobayashi S. Lymphaticovenous shunt for the treatment of chylous reflux by subcutaneous vein grafts with valves between megalymphatics and the great saphenous vein: a case report. Microsurgery. 2010;30(7):553-556.

    Article  PubMed  Google Scholar 

  36. Maegawa J, Mikami T, Yamamoto Y, Satake T, Kobayashi S. Types of lymphoscintigraphy and indications for lymphaticovenous anastomosis. Microsurgery. 2010;30(6):437-442.

    Article  PubMed  Google Scholar 

  37. Noel AA, Gloviczki P, Bender CE, Whitley D, Stanson AW, Deschamps C. Treatment of symptomatic primary chylous disorders. J Vasc Surg. 2001;34(5):785-791.

    Article  PubMed  CAS  Google Scholar 

  38. Campisi C. Use of autologous interposition vein graft in management of lymphedema: preliminary experimental and clinical observations. Lymphology. 1991;24(2):71-76.

    PubMed  CAS  Google Scholar 

  39. Becker C, Assouad J, Riquet M, Hidden G. Postmastectomy lymphedema: long-term results following microsurgical lymph node transplantation. Ann Surg. 2006;243(3):313-315.

    Article  PubMed  Google Scholar 

  40. Gloviczki P. Principles of surgical treatment of chronic lymphedema. In: Gloviczki P, ed. Handbook of Venous Disorders: Guidelines of the American Venous Forum. 3rd ed. London: Hodder Arnold; 2009:658-664.

    Google Scholar 

  41. Lee B, Andrade M, Bergan J, et al. Diagnosis and treatment of primary lymphedema. Consensus Document of the International Union of Phlebology (IUP)-2009. Int Angiol. 2010;29(5):454-470.

    PubMed  CAS  Google Scholar 

  42. Brorson H, Svensson H. Liposuction combined with controlled compression therapy reduces arm lymphedema more effectively than controlled compression therapy alone. Plast Reconstr Surg. 1998;102(4):1058-1067; discussion 68.

    Article  PubMed  CAS  Google Scholar 

  43. Brorson H. From lymph to fat: complete reduction of lymphoedema. Phlebology. 2010;25(suppl 1):52-63.

    Article  PubMed  Google Scholar 

  44. Gloviczki P. Principles of surgical treatment of chronic lymphoedema. Int Angiol. 1999;18(1):42-46.

    PubMed  CAS  Google Scholar 

  45. Gamble GL, Cheville A, Strick D. Lymphedema: medical and physical therapy. In: Gloviczki P, ed. Handbook of Venous Disorders: Guidelines of the American Venous Forum. 3rd ed. London: Hodder Arnold; 2009:649-657.

    Google Scholar 

  46. Gloviczki P, Calcagno D, Schirger A, et al. Noninvasive evaluation of the swollen extremity: experiences with 190 lymphoscintigraphic examinations. J Vasc Surg. 1989;9(5):683-689; discussion 90.

    Article  PubMed  CAS  Google Scholar 

  47. Cambria RA, Gloviczki P, Naessens JM, Wahner HW. Noninvasive evaluation of the lymphatic system with lymphoscintigraphy: a prospective, semiquantitative analysis in 386 extremities. J Vasc Surg. 1993;18(5):773-782.

    Article  PubMed  CAS  Google Scholar 

  48. Lohrmann C, Felmerer G, Foeldi E, Bartholoma JP, Langer M. MR lymphangiography for the assessment of the lymphatic system in patients undergoing microsurgical reconstructions of lymphatic vessels. Microvasc Res. 2008;76(1):42-45.

    Article  PubMed  Google Scholar 

  49. Olszewski WL. Physiology and microsurgery of lymphatic vessels in man. Lymphology. 1981;14(2):44-60.

    PubMed  CAS  Google Scholar 

  50. Nielubowicz J, Olszewski W, Sokolowski J. Surgical lympho-venous shunts. J Cardiovasc Surg. 1968;9(3):262-267.

    CAS  Google Scholar 

  51. Degni M. New technique of lymphatic-venous anastomosis for the treatment of lymphedema. J Cardiovasc Surg. 1978;19(6):577-580.

    CAS  Google Scholar 

  52. Campisi C, Boccardo F. Role of microsurgery in the management of lymphoedema. Int Angiol. 1999;18(1):47-51.

    PubMed  CAS  Google Scholar 

  53. Damstra RJ, Voesten HG, van Schelven WD, van der Lei B. Lymphatic venous anastomosis (LVA) for treatment of secondary arm lymphedema. A prospective study of 11 LVA procedures in 10 patients with breast cancer related lymphedema and a critical review of the literature. Breast Cancer Res Treat. 2009;113(2):199-206.

    Article  PubMed  CAS  Google Scholar 

  54. O’Brien BM, Shafiroff BB. Microlymphaticovenous and resectional surgery in obstructive lymphedema. World J Surg. 1979;3(1):3-15, 121-123.

    Article  PubMed  Google Scholar 

  55. Koshima I, Inagawa K, Urushibara K, Moriguchi T. Supermicrosurgical lymphaticovenular anastomosis for the treatment of lymphedema in the upper extremities. J Reconstr Microsurg. 2000;16(6):437-442.

    Article  PubMed  CAS  Google Scholar 

  56. Gloviczki P, Noel AA. Surgical treatment of chronic lymphedema and primary chylous disorders. In: Rutherford RB, ed. Rutherford’s Vascular Surgery. 6th ed. Philadelphia: Elsevier; 2005:2428-2445.

    Google Scholar 

  57. Vignes S, Boursier V, Priollet P, Miserey G, Trevidic P. Quantitative evaluation and qualitative results of surgical lymphovenous anastomosis in lower limb lymphedema. J Mal Vasc. 2003;28(1):30-35.

    PubMed  CAS  Google Scholar 

  58. Campisi C, Boccardo F, Zilli A, Maccio A, Napoli F. Long-term results after lymphatic-venous anastomoses for the treatment of obstructive lymphedema. Microsurgery. 2001;21(4):135-139.

    Article  PubMed  CAS  Google Scholar 

  59. Campisi C, Boccardo F. Lymphedema and microsurgery. Microsurgery. 2002;22(2):74-80.

    Article  PubMed  CAS  Google Scholar 

  60. Campisi C, Eretta C, Pertile D, et al. Microsurgery for treatment of peripheral lymphedema: long-term outcome and future perspectives. Microsurgery. 2007;27(4):333-338.

    Article  PubMed  Google Scholar 

  61. Takeishi M, Kojima M, Mori K, Kurihara K, Sasaki H. Primary intrapelvic lymphaticovenular anastomosis following lymph node dissection. Ann Plast Surg. 2006;57(3):300-304.

    Article  PubMed  CAS  Google Scholar 

  62. Weiss M, Baumeister RG, Hahn K. Dynamic lymph flow imaging in patients with oedema of the lower limb for evaluation of the functional outcome after autologous lymph vessel transplantation: an 8-year follow-up study. Eur J Nucl Med Mol Imaging. 2003;30(2):202-206.

    Article  PubMed  Google Scholar 

  63. Becker C, Hidden G. Transfer of free lymphatic flaps. Microsurgery and anatomical study. J Mal Vasc. 1988;13(2):119-122.

    PubMed  CAS  Google Scholar 

  64. Puckett CL, Jacobs GR, Hurvitz JS, Silver D. Evaluation of lymphovenous anastomoses in obstructive lymphedema. Plast Reconstr Surg. 1980;66(1):116-120.

    Article  PubMed  CAS  Google Scholar 

  65. Clodius L, Piller NB, Casley-Smith JR. The problems of lymphatic microsurgery for lymphedema. Lymphology. 1981;14(2):69-76.

    PubMed  CAS  Google Scholar 

  66. Foldi E, Foldi M, Clodius L. The lymphedema chaos: a lancet. Ann Plast Surg. 1989;22(6):505-515.

    Article  PubMed  CAS  Google Scholar 

  67. Foldi M, Foldi E, Kubik S. Textbook of Lymphology for Physicians and Lymphedema Therapists. Munchen: Urban & Fischer; 2003.

    Google Scholar 

  68. Weiss M, Baumeister RG, Hahn K. Planning and monitoring of autologous lymph vessel transplantation by means of nuclear medicine lymphoscintigraphy. Handchir Mikrochir Plast Chir. 2003;35(4):210-215.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer-Verlag London Limited

About this chapter

Cite this chapter

Gloviczki, P. (2011). General Principles and Indications. In: Lee, BB., Bergan, J., Rockson, S. (eds) Lymphedema. Springer, London. https://doi.org/10.1007/978-0-85729-567-5_40

Download citation

  • DOI: https://doi.org/10.1007/978-0-85729-567-5_40

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-0-85729-566-8

  • Online ISBN: 978-0-85729-567-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics