Surgical Treatment for Lymphedema: Optimal Timing and Optimal Techniques

none4Melissa Ryan;Corrado Cesare Campisi;Francesco Boccardo;Corradino CampisiMelissa, Ryan; Campisi, Corrado; Boccardo, Francesco; Campisi, Corradin

Evolution of chylous fistula management after neck dissection

The present review is focused on the management of lymphatic, chylous, and thoracic duct lesions following head and neck surgery, with particular attention to these complications after neck dissection. Postoperative scenarios may include chylous fistula, chylothorax, chylomediastinum, chylopericardium, lymphocele, persistent lymphorrhea, and secondary lymphedema

Surgical Research, Staging-Guided Technical Procedures and Long-Term Clinical Outcomes for the Treatment of Peripheral Lymphedema: the Genoa Protocol

The Author ’s vast surgical experience in the treatment of primary and secondary peripheral lymphedema is reported. The objective is to describe the techniques and the long-lasting clinical outcomes based on more than 45 years research and clinical applications, with particular reference to staging-guided derivative and reconstructive lymphatic microsurgery at a single site, and to complementary, sequential, minimally invasive procedures of selective liposuction.5.046 cases of patients (demographic characteristics are at length described) affected by upper and/or lower limb lymphedema, between 1973 and 2020, underwent lymphatic microsurgery and, between 2012 and 2020, Fibro-Lipo-Lymph-Aspiration according to Lymph Vessel Sparing Procedure (FLLA-LVSP), for latest stages of Lymphedema previously treated by Lymphatic Microsurgery with partial improvement of the disease. Derivative Multiple Lymphatic-Venous Anastomoses (MLVA) or, in selected cases of Phlebolymphedema absolutely contraindicating derivative procedures, lymphatic pathway reconstruction, using interpositioned vein grafted shunts (Multiple-Lymphatic-Venous-Lymphatic Anastomose - MLVLA), above all at lower limbs, were performed at a single site, either the brachial-axillary or inguinal-crural region.Adopted surgical techniques are described in detail. As far as exposition of results is concerned, patients were followed up for a minimum of 5 years to over 20 years. Clinical outcomes included excess limb volume (ELV), frequency of dermatolymphangioadenitis (DLA) attacks, lymphoscintigraphy, and use of conservative therapies.Compared with preoperative conditions, patients obtained significant reduction in ELV of over 90%, with an average follow-up of 10 years or more. Over 96% of patients with earlier stages of disease (stage IB or IIA) progressively stopped using conservative therapies and over 80% of patients with later stages (stages IIB and III) significantly decreased the frequency of physical therapies and discontinued compressive garments or stockings. DLA attacks considerably reduced by over 95%.MLVA or MLVLA techniques when performed at a single site produce excellent outcomes in the treatment of both primary and secondary lymphedemas, giving the possibility of a complete restoration of lymphatic flow in early stages of disease, when tissue changes are minimal. For late stages of lymphedema only partially responding to MLVA or MLVLA, FLLA-LVSP sequential procedures can significantly improve the long-term clinical outcomes.&nbsp;Staging-guided treatment of peripheral lymphedema, according to Authors’ Genoa Protocol, carries out contextual target of primary, secondary and tertiary prevention in the potential worsening of the disease.</p

Left Atrial Strain Imaging by Speckle Tracking Echocardiography: The Supportive Diagnostic Value in Cardiac Amyloidosis and Hypertrophic Cardiomyopathy

Background: Left atrial (LA) function is crucial for assessing left ventricular filling in various cardiovascular conditions. Cardiac Amyloidosis (CA) is characterized by atrial myopathy and LA function impairment, with diastolic dysfunction up to restrictive filling pattern, leading to progressive heart failure and arrhythmias. This study evaluates LA function and deformation using speckle tracking echocardiography (STE) in patients with CA compared to a cohort of patients with sarcomeric Hypertrophic Cardiomyopathy (HCM) and a control group. Methods: We conducted a retrospective, observational study (from January 2019 to December 2022) including a total of 100 patients: 33 with ATTR-CA, 34 with HCMs, and 33 controls. Clinical evaluation, electrocardiograms, and transthoracic echocardiography were performed. Echocardiogram images were analyzed in post-processing using EchoPac software for LA strain quantification, including LA-reservoir, LA-conduit, and LA-contraction strain. Results: The CA group exhibited significantly impaired LA function compared to HCMs and control groups, with LA-reservoir median values of −9%, LA-conduit −6.7%, and LA-contraction −3%; this impairment was consistent even in the CA subgroup with preserved ejection fraction. LA strain parameters correlated with LV mass index, LA volume index, E/e’, and LV-global longitudinal strain and were found to be associated with atrial fibrillation and exertional dyspnea. Conclusions: LA function assessed by STE is significantly impaired in CA patients compared to HCMs patients and healthy controls. These findings highlight the potential supportive role of STE in the early detection and management of the disease

Global guidelines trends and controversies in lower limb venous and lymphatic disease: Narrative literature revision and experts\u27 opinions following the vWINter international meeting in Phlebology, Lymphology & Aesthetics, 23-25 January 2019.

Guidelines are fundamental in addressing everyday clinical indications and in reporting the current evidence-based data of related scientific investigations. At the same time, a spatial and temporal issue can limit their value. Indeed, variability in the recommendations can be found both among the same nation different scientific societies and among different nations/continents. On the other side, Garcia already published in 2014 data showing how, after three years in average, one out of five recommendations gets outdated (Martinez Garcia LM, Sanabria AJ, Garcia Alvarez E, et al. The validity of recommendations from clinical guidelines: a survival analysis. CMAJ 2014;186(16):1211-1219). The present document reports a narrative literature revision on the major international recommendations in lower limb venous and lymphatic disease management, focusing on the different countries' guidelines, trends and controversies from all the continents, while identifying new evidence-based data potentially influencing future guidelines. World renowned experts' opinions are also provided. The document has been written following the recorded round tables scientific discussions held at the vWINter international meeting (22-26 January 2019; Cortina d'Ampezzo, Italy) and the pre- and post-meeting literature search performed by the leading experts