Doppler evaluation of external iliac vein hemodynamic changes caused by lymphocele after lymphadenectomy for cervical cancer.
OBJECTIVE
To use Doppler sonography to assess the hemodynamic changes in the external iliac vein (EIV) compressed by a pelvic lymphocele after pelvic lymphadenectomy in patients with cervical cancer.


METHODS
Postoperative gray-scale and Doppler sonographic examinations were performed in 71 women after pelvic lymphadenectomy. Twenty healthy women served as controls. When present, the lymphocele was graded on a scale of 1 to 4 based on the percentage of the circumference of iliac vessels in contact with the lymphocele (ie, circumferential contiguity) (grade 1, 0-24%; grade 2, 25-49%; grade 3, 50-74%; grade 4, 75-100%), and in 3 groups according to its maximum diameter (group A, 1-40 mm; group B, 41-60 mm; group C, >60 mm). EIV velocity was measured, and waveform modulation by respiratory movements was analyzed.


RESULTS
There were 40 lymphoceles in 22 patients. The mean (+/-SD) EIV velocity was 24.5 +/- 14.8 cm/s in the control group, 38.2 +/- 5.9 cm/s in group 1, 69.2 +/- 29.4 cm/s in group 2, 105.75 +/- 12.36 cm/s in group 3, and 139.5 +/- 33.79 cm/s in group 4. Spontaneous EIV blood flow could not be detected in 2 cases in the later group. EIV flow modulation was significantly lower in patients with greater lymphocele contiguity or diameter.


CONCLUSIONS
Post-pelvic lymphadenectomy causes EIV extrinsic compression that results in upstream blood stasis, potentially increasing the risk for deep vein thrombosis.
Bianek-Bodzak
Agnieszka
A
The First Radiology Unit, Medical University of Gdansk, ul. Kliniczna 1 a 80-402, Gdansk, Poland.
Sliwinski
Wojciech
W
Mielcarek
Piotr
P
D001783:Blood Flow Velocity; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007084:Iliac Vein / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008197:Lymph Node Excision / Q000009:adverse effects*; D008210:Lymphocele / Q000150:complications* / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D018608:Ultrasonography, Doppler; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*