A. MACCIÒ 1-2, F. BOCCARDO 1, V. LA GANGA 2, R. LO GIUDICE 2, A. MONTOBBIO 2, C. CAMPISI
1) Department of Surgery – General Surgery, Lymphatic Surgery and Microsurgery
San Martino Hospital – University of Genoa, Italy
2) “Prevention, Diagnosis and Therapy of Lymphatic and Chyliferes Vessels Diseases” Ambulatory
Service of Lymphology – S.C. General Surgery – Ovada Hospital, ASL 22 Piedmont, Italy
Correspondence authors: francesco.boccardo@unige.it – campisi@unige.it
ABSTRACT
Purpose: Before a lower limb surgical operation due to venous
disease, it is necessary to immediately evaluate the presence and
seriousness of the concurrent lymphatic deficiency.
Methods: Besides objective test that can reveal a clinically
evident lymphatic deficiency, it is helpful to investigate family and
remote pathological anamnesis to identify possible risk factors or
specific family propensities. As far as instrumental tests are
concerned, it is advisable to perform both a doppler
ultrasonographic examination and a limb segmentary
Lymphoscintigraphy. The most risky area is the inguinal one,
where lymphatic collector vessels join main lymph-nodal
structures. Obviously, lesions of these structures may start a
lymphatic deficiency, but it is also important to underline that scar
reactions and relevant fibrosis, that may characterize an even
normal post-operation period, may create a further obstacle to
normal lymphatic drain.
Results and Conclusions: Special attention has to be paid to
precise indications and venous surgery technique in mixed clinical
situations, when both venous and lymphatic systems are involved,
to avoid potential clinical state worsening. Finally, diagnostic and
therapeutical prevention modalities for possible lymphatic injuries
in CVI affected limbs have to be kept into consideration, up to
microsurgical technique application. Hopefully therefore, with the
purpose of a correct preventive and not invasive surgical
operation, more an more attention will be paid regarding potential
lymphatic impairment derived from venous surgery.