Presentation is loading. Please wait.

Presentation is loading. Please wait.

Diagnosis and treatment of venous lymphedema

Published byFrederica Horn Modified over 5 years ago

Similar presentations

Presentation on theme: "Diagnosis and treatment of venous lymphedema"— Presentation transcript:

1 Diagnosis and treatment of venous lymphedema
Seshadri Raju, MD, James Brooke Furrh, BS, Peter Neglén, MD, PhD  Journal of Vascular Surgery  Volume 55, Issue 1, Pages (January 2012) DOI: /j.jvs Copyright © 2012 Society for Vascular Surgery Terms and Conditions

2 Fig 1 Swelling in the dorsum foot, squaring of toes, and Stemmer sign are widely considered “classic” clinical features of lymphedema. In our experience, these may also be present in long-standing venous swelling and are not exclusive to lymphedema (see text). Left, This patient was diagnosed as having “lymphedema” on clinical grounds and was treated for several decades with compression, which was ineffective. Middle, Isotope lymphangiography was normal. Right, Transfemoral venography showed postthrombotic iliac vein stenosis (left venogram is shown). Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

3 Fig 2 This patient had onset of leg swelling from early adolescence. Lymphatic delay was noted on the right side but was normal on the left. Venogram showed bilateral iliac vein stenoses. Right limb venogram is shown with severe diffuse iliac vein stenosis. Note the normal caliber of the femoral vein. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

4 Fig 3 Venography is poorly sensitive to iliac vein obstruction. Left, A venogram appears unremarkable. Right, A tight stenosis is present, as shown by the IVUS image. Measured lumen area by IVUS planimetry was 44.3 mm2. Normal value in adults is ∼175 mm2. A 75% stenosis can therefore be calculated to be present. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

5 Fig 4 In some cases, lymphatic delay (left) with standard technique will normalize if triple dose of the isotope-tagged colloid is injected (right). Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

6 Fig 5 Cumulative stent patency in abnormal lymphangiographic group. Assisted primary and secondary patency curves were the same. The error bars show the standard deviation. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

7 Fig 6 Swelling relief (cumulative) is shown after stent placement in lymphedematous limbs. Separate curves are shown for subjective relief, as reported by the patient, and for objective relief by examination. The difference in the curves may partly be due to metrics (see text). The error bars show the standard deviation. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

8 Fig 7 Left, Lymphographic nonvisualization of inguinal nodes in a patient with right-sided lymphedema. Right, After iliac vein stent placement, nodes promptly visualized at 20 minutes. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Download ppt "Diagnosis and treatment of venous lymphedema"

Similar presentations

Gregory J. Nadolski, MD, S. William Stavropoulos, MD 

Gregory J. Nadolski, MD, S. William Stavropoulos, MD 
Adam W. Beck, MD, Erin H. Murphy, MD, Jennie A

Adam W. Beck, MD, Erin H. Murphy, MD, Jennie A
Arterioarterial prosthetic loop: A new approach for hemodialysis access  Juergen Zanow, MD, Ulf Kruger, MD, Michael Petzold, MD, Karen Petzold, MD, Helga.

Arterioarterial prosthetic loop: A new approach for hemodialysis access  Juergen Zanow, MD, Ulf Kruger, MD, Michael Petzold, MD, Karen Petzold, MD, Helga.
Seshadri Raju, MD, Kathryn Hollis, BA, Peter Neglen, MD, PhD 

Seshadri Raju, MD, Kathryn Hollis, BA, Peter Neglen, MD, PhD 
Iliac vein stenting in postmenopausal leg swelling

Iliac vein stenting in postmenopausal leg swelling
Proximal radial artery arteriovenous fistula for hemodialysis vascular access  William C. Jennings, MD, Alexandros Mallios, MD, Nasir Mushtaq, PhD, MBBS,

Proximal radial artery arteriovenous fistula for hemodialysis vascular access  William C. Jennings, MD, Alexandros Mallios, MD, Nasir Mushtaq, PhD, MBBS,
A patient with multiple paradoxical emboli

A patient with multiple paradoxical emboli
Heart failure is associated with reduced patency after endovascular intervention for symptomatic peripheral arterial disease  Andrew J. Meltzer, MD, Gautam.

Heart failure is associated with reduced patency after endovascular intervention for symptomatic peripheral arterial disease  Andrew J. Meltzer, MD, Gautam.
Mid-term results of endovascular treatment for symptomatic chronic nonmalignant iliocaval venous occlusive disease  Olivier Hartung, MD, Andres Otero,

Mid-term results of endovascular treatment for symptomatic chronic nonmalignant iliocaval venous occlusive disease  Olivier Hartung, MD, Andres Otero,
Venous stenting across the inguinal ligament

Venous stenting across the inguinal ligament
Noninvasive evaluation of the lymphatic system with lymphoscintigraphy: A prospective, semiquantitative analysis in 386 extremities  Robert A. Cambria,

Noninvasive evaluation of the lymphatic system with lymphoscintigraphy: A prospective, semiquantitative analysis in 386 extremities  Robert A. Cambria,
Successful endovascular management of an acute iliac venous injury during lumbar discectomy and anterior spinal fusion  Joseph R. Schneider, MD, PhD,

Successful endovascular management of an acute iliac venous injury during lumbar discectomy and anterior spinal fusion  Joseph R. Schneider, MD, PhD,
Iliac-caval stenting in the obese

Iliac-caval stenting in the obese
Compression therapy and liposuction of lower legs for bilateral hereditary primary lymphedema praecox  Antonio Espinosa-de-los-Monteros, MD, Carlos A.

Compression therapy and liposuction of lower legs for bilateral hereditary primary lymphedema praecox  Antonio Espinosa-de-los-Monteros, MD, Carlos A.
Postthrombotic or non-postthrombotic severe venous insufficiency: Impact of removal of superficial venous reflux with or without subcutaneous fasciotomy 

Postthrombotic or non-postthrombotic severe venous insufficiency: Impact of removal of superficial venous reflux with or without subcutaneous fasciotomy 
Persistent sciatic artery and vein: An unusual case

Persistent sciatic artery and vein: An unusual case
High prevalence of nonthrombotic iliac vein lesions in chronic venous disease: A permissive role in pathogenicity  Seshadri Raju, MD, Peter Neglen, MD,

High prevalence of nonthrombotic iliac vein lesions in chronic venous disease: A permissive role in pathogenicity  Seshadri Raju, MD, Peter Neglen, MD,
May-Thurner syndrome and iliac arteriovenous fistula in an elderly woman  Nancy Huynh, BS, Lindsay Gates, MD, Leslie Scoutt, MD, Bauer Sumpio, MD, PhD,

May-Thurner syndrome and iliac arteriovenous fistula in an elderly woman  Nancy Huynh, BS, Lindsay Gates, MD, Leslie Scoutt, MD, Bauer Sumpio, MD, PhD,
Unexpected major role for venous stenting in deep reflux disease

Unexpected major role for venous stenting in deep reflux disease
Ali F. AbuRahma, MD, J. David Hayes, MD, Sarah K

Ali F. AbuRahma, MD, J. David Hayes, MD, Sarah K

Similar presentations

Ads by Google