title: Doppler evaluation of external iliac vein hemodynamic changes caused by lymphocele after lymphadenectomy for cervical cancer.
abstract: 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.
authors.affiliation: The First Radiology Unit, Medical University of Gdansk, ul. Kliniczna 1 a 80-402, Gdansk, Poland.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Bianek-Bodzak
authors.forename: Wojciech
authors.initials: W
authors.lastname: Sliwinski
authors.forename: Piotr
authors.initials: P
authors.lastname: Mielcarek
mesh_terms: 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*