title: Diagnosis and treatment of concomitant venous obstruction in patients with secondary lymphedema.
abstract: OBJECTIVE
  It has been proposed that concomitant iatrogenic venous obstruction substantially contributes to the appearance and severity of the secondary lymphedema that follows cancer surgery, radiation, and other traumas. The purpose of this study was to investigate the frequency of venous obstruction in the clinical presentation of patients with secondary lymphedema and to analyze the efficacy of interventional therapy in this patient population.
  
  
  METHODS
  The experience of the university center for lymphatic and venous disorders with combined lymphaticovenous edema was retrospectively examined. The records and clinical course were reviewed for all patients referred to a university lymphedema center for evaluation between January 1996 and March 1999. During this interval, in 365 patients with lymphedema, 35 radiocontrast venograms were obtained to evaluate the suspected presence of mixed lymphaticovenous edema. Venographic evidence of venous stenosis (>50%) or occlusion was analyzed, as were the technical success of the intervention, determined by ability to cross the affected segment of the vein and perform venoplasty and place the stent, and the clinical success of the intervention assessed by relief of clinical symptoms (edema, pain) within 24 hours.
  
  
  RESULTS
  The diagnosis of venous obstruction was confirmed in 17 patients (4.6% of all patients with lymphedema; 49% of patients studied with venography). Venography disclosed clinically relevant venous stenosis in five of seven patients with edema of the upper extremity and in six of 10 patients with leg lymphedema. Venous occlusion was found in two of seven patients with upper extremity edema and in four of 10 patients with leg lymphedema. Percutaneous endovascular venoplasty was attempted in all 17 patients and was successful in 16. Subsequent venous stent placement was performed in three patients with upper extremity edema and in all patients with lower extremity lymphedema. Clinical amelioration of edema was observed in 15 of these 17 patients. Amelioration was assessed by relief of symptoms, improvement in function, and reduction in limb girth.
  
  
  CONCLUSIONS
  This study supports the clinical importance of concomitant venous obstruction in some patients with chronic secondary lymphedema. Edema can often be ameliorated through percutaneous catheter-based interventions.
authors.affiliation: Division of Cardiovascular Medicine, Division of Interventional Radiology, Stanford University School of Medicine, Stanford, California 94305, USA.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Szuba
authors.forename: Mahmood
authors.initials: M
authors.lastname: Razavi
authors.forename: Stanley G
authors.initials: SG
authors.lastname: Rockson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000628:therapy; D005121:Extremities / Q000098:blood supply; D005260:Female; D006801:Humans; D008209:Lymphedema / Q000150:complications* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy; D010690:Phlebography; D015641:Radiography, Interventional; D012189:Retrospective Studies; D015607:Stents; D014680:Veins / Q000473:pathology