Management of Upper Extremity Lymphoedema with Microsurgical Lympho-Venous Anastomosis (LVA)

  • Corradino Campisi
  • Francesco Boccardo

Case Report

A 59 year old woman presented with an 8 year history of edema of the left arm. Initially, the edema appeared in the upper arm. The patient was treated with combined decongestive physiotherapy (manual and mechanical lymphatic drainage), bandaging and exercises three to four times over a 12 month period. Despite these measures, the edema later extended to the forearm and hand (Fig. 57.1). In the months preceding her admission she developed several episodes of erysipeloid lymphangitis and pain. There were no warts or wounds on the skin. Her past medical history included lumpectomy with axillary lymphadenectomy and radiotherapy for left breast cancer. There was no suggestion of local recurrence on routine follow-up.


  1. 1.
    Badini A, Fulcheri E, Campisi C, Boccardo F. A new approach in histopathological diagnosis of lymphoedema: pathophysiological and therapeutic implications. Lymphology. 1996;29(S):190–8.Google Scholar
  2. 2.
    Papendieck CM. Temas de Angiologia Pediatrica. Buenos Aires: Editorial Medica Panamericana; 1992.Google Scholar
  3. 3.
    Farrar WB, Lavalle G, Kim JA. Breast cancer. In: McKenna RJ, Murphy GP, editors. Cancer surgery. Philadelphia: Lippincott; 1994. p. 209–59.Google Scholar
  4. 4.
    Witte CL. Breast cancer – an overview. Lymphology. 1994;27S:397–400.Google Scholar
  5. 5.
    Tosatti E. Lymphatique profonds et lymphoedèmes chroniques des membres. Paris: Masson; 1974.Google Scholar
  6. 6.
    Mayall JC, Mayall ACDG. Standardization of methods of treatment of Lymphoedema. Progress in Lymphology XI. Excerpta Med. 1988;517Google Scholar
  7. 7.
    Mariani G, Campisi C, Taddei G, Boccardo F. The current role of lymphoscintigraphy in the diagnostic evaluation of patients with peripheral lymphoedema. Lymphology. 1998;31(S):316–9.Google Scholar
  8. 8.
    Witte C, McNeill G, Witte M, et al. Whole-body lymphangioscintigraphy: making the invisible easily visible. In: Progress in Lymphology XII. Elsevier Science BV; 1989. p. 123.Google Scholar
  9. 9.
    Bourgeois P, Leduc O, Leduc A. Imaging techniques in the management and prevention of posttherapeutic upper limb oedemas. Cancer. 1998;83(12 Suppl American):2805–13.CrossRefPubMedGoogle Scholar
  10. 10.
    Kinmonth JB. The lymphatics. Surgery, lymphography and diseases of the chyle and lymph systems. London: Edward Arnold; 1982.Google Scholar
  11. 11.
    Bruna J. Indication for lymphography in the era of new imaging methods. Lymphology. 1994;27(S):319–20.Google Scholar
  12. 12.
    Campisi C, Boccardo F, Zilli A, Borrelli V. Chylous reflux pathologies: diagnosis and microsurgical treatment. Int Angiol. 1999;18:10–3.PubMedGoogle Scholar
  13. 13.
    Partsch H. Indirect lymphography in different kinds of leg oedema. In: Lymphology: advances in Europe. Genova: Ecig; 1989. p. 95–9.Google Scholar
  14. 14.
    Bollinger A, Jager K, Sgier F, Seglias J. Fluorescence microlymphography. Circulation. 1981;64:195–200.CrossRefGoogle Scholar
  15. 15.
    Olszewski W. Lymph and tissue pressures in patients with lymphoedema during massage and walking with elastic support. Lymphology. 1994;27(S):512–6.Google Scholar
  16. 16.
    Campisi C, Olszewski W, Boccardo F. Il gradiente pressorio linfo-venoso in microchirurgia linfatica. Minerva Angiologica. 1994;19Google Scholar
  17. 17.
    La VE. Méthode Vodder – Le Drainage Lymphatique Manuel. Institute for Lymphdrainage: Bagsvaer; 1969.Google Scholar
  18. 18.
    Földi M. The therapy of lymphoedema. EJLRP. 1993–1994;14:43–9.Google Scholar
  19. 19.
    Leduc A. Le drainage lymphatique. Théorie et pratique. Paris: Masson; 1980.Google Scholar
  20. 20.
    Olszewski WL. Recurrent bacterial dermatolymphangioadenitis (DLA) is responsible for progression of lymphoedema. Lymphology. 1996;29S:331.Google Scholar
  21. 21.
    Casley-Smith JR, Casley-Smith RJ. High-protein oedemas and the Benzo-Pyrones. Sydney: Lippincott; 1986.Google Scholar
  22. 22.
    Charles RH. A system of treatment. In: Latham A, English TC, editors. Lymphoedema. London: Churchill; 1912.Google Scholar
  23. 23.
    Thompson N. The surgical treatment of chronic lymphoedema of the extremities. Surg Clin North Am. 1967;47(2)Google Scholar
  24. 24.
    Servelle M. Pathologie vasculaire. Paris: Masson; 1975.Google Scholar
  25. 25.
    O’Brien B. Microlymphatic-venous and resectional surgery in obstructive lymphoedemas. World J Surg. 1979;3:3.CrossRefPubMedGoogle Scholar
  26. 26.
    Degni M. New techniques of lymphatic-venous anastomosis for the treatment of lymphoedema. Cardiovas Riv Bras. 1974;10:175.Google Scholar
  27. 27.
    Campisi C. Rational approach in the management of lymphoedema. Lymphology. 1991;24:48–53.PubMedGoogle Scholar
  28. 28.
    Campisi C, Davini D, Bellini C, et al. Lymphatic microsurgery for the treatment of lymphedema. Microsurgery. 2006;26(1):65–9.CrossRefPubMedGoogle Scholar
  29. 29.
    Campisi C. Lymphatic microsurgery: a potent weapon in the war on lymphoedema. Lymphology. 1995;28:110–2.PubMedGoogle Scholar
  30. 30.
    Campisi C, Boccardo F. Frontiers in lymphatic microsurgery. Microsurgery. 1998;18:462–71.CrossRefPubMedGoogle Scholar
  31. 31.
    Baumeister RGH. Clinical results of autogenous lymphatic grafts in the treatment of lymphoedemas. In: Partsch H, editor. Progress in Lymphology XI. Elsevier: Science BV; 1988. p. 419–20.Google Scholar
  32. 32.
    Campisi C. Use of autologous interposition vein graft in management of lymphoedema. Lymphology. 1991;24:71–6.PubMedGoogle Scholar
  33. 33.
    Becker C, Hidden G, Godart S, Maurage H, Pecking A. Free lymphatic transplant. EJLRP. 1991;2:75–7.Google Scholar
  34. 34.
    Trévidic P, Marzelle J, Cormier JM. Apport de la microchirurgie au traitement des lymphoedèmes. Editions Techniques. Encycl Méd Chir (Paris-France)., Techniques chirurgicales – Chirurgie Vasculaire. 1994;F.a:43–225, 3.Google Scholar
  35. 35.
    Campisi C. Lymphoedema: modern diagnostic and therapeutic aspects. Int Angiol. 1999;18:14–24.PubMedGoogle Scholar
  36. 36.
    Campisi C, Boccardo F. Role of microsurgery in the management of lymphoedema. Int Angiol. 1999;18:47–51.PubMedGoogle Scholar
  37. 37.
    Pecking AP, et al. Upper limb lymphedema’s frequency in patients treated by conservative therapy in breast cancer. Lymphology. 1996;29S:293–6.Google Scholar
  38. 38.
    Campisi C, Davini D, Bellini C, et al. Is there a role for microsurgery in the prevention of arm lymphedema secondary to breast cancer treatment? Microsurgery. 2006;26(1):70–2.CrossRefPubMedGoogle Scholar
  39. 39.
    Pissas A. Prevention of secondary lymphoedema. In: Proceedings of the International Congress of Phlebology, Corfù, Greece, 113, September 4–8; 1996.Google Scholar
  40. 40.
    Casley-Smith JR. Alterations of untreated lymphedema and its grades over time. Lymphology. 1995;28:174–85.PubMedGoogle Scholar
  41. 41.
    Boccardo F, Casabona F, De Cian F, et al. Lymphedema microsurgical preventive healing approach: a new technique for primary prevention of arm lymphedema after mastectomy. Ann Surg Oncol. 2009;16:703–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of General SurgeryUniversity Hospital, San MartinoGenoaItaly
  2. 2.Professorial Unit of Medical OncologyUniversity and National Cancer, Research InstituteGenoaItaly

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