Lymphedema

Byung-Boong Lee John Bergan Stanley G. Rockson

Editors

The entire field of vascular diseases has experienced phenomenal progress during the past few decades. Multiple books and journal publications are silent witnesses to the dramatic advances in the diagnosis and management of arterial and venous diseases. Endovascular prosthesis, bare and covered stents, and complex endolumi­nal techniques dealing with the devastating sequelae of atherosclerosis have dra­matically changed our approach to abdominal and thoracic aneurysms, obstructive coronary and carotid lesions, as well as arterial occlusion of the extremities. The same technological revolution has reached the field of venous diseases. The tradi­tional “long and short” saphenous stripping for varicose veins that many of us per­formed during decades of vascular surgery practice, have been replaced by foam sclerotherapy, radiofrequency, and laser catheters. Dermatologists, interventional radiologists, cardiologists, and other non-surgical specialists have entered the endovenous therapy field en masse. Prestigious societies devoted to the study and care of patients with venous diseases have sprouted worldwide for the benefit of the millions of patients suffering from diseases of the veins. The majority of papers published in vascular journals deal with arterial topics, a few on venous diseases, and even fewer on lymphatic disorders.

The recently published third edition of The Handbook of Venous Disorders of the American Venous Forum dedicates only 42 of its 744 pages to lymphatic diseases. The prestigious Journal of Vascular Surgery publishes annually a relatively small number of papers on the lymphatic system.

to visualize cutaneous and deeper lymphatics, followed the technique of oil lym­phography and lymphadenography, as described by Kinmonth. These techniques were a useful tool in the study of the lymphatic vasculature and served as a basis for a working classification of lymphedemas. The tedious and time-consuming lym­phography has been replaced by new nuclear medicine imaging techniques, radio­nuclide lymphoscintigraphy, multislice CT, magnetic resonance imaging, and computerized axial tomography. These techniques have contributed to guiding the clinician in the process of establishing a rational diagnosis and dictating appropriate treatment. Advances in diagnosis have been followed by an array of therapeutic techniques. Many of them are described in this book by their original authors. Because of my long-time interest in the subject, I have had personal experience in some of the diagnostic and surgical techniques described in this book, such as oil lymphography, lymphoscintigraphy, lymphovenous anastomosis, and debulking procedures for massive lymphedema. I consider, however, that at present, a program of complex manual decongestive technique associated with properly applied inter­mittent pneumatic compression and followed by well-supervised compression ther­apy in a compliant patient may achieve long-lasting edema control without the need for surgery. The role of surgery, as described in surgical books and texts on vascular surgery, has been relegated to a few cases of severe fibro-lymphedema and to recon­structive plastic surgery to excise and remodel the redundant skin folds resulting from a good lymphatic manual decompression program of the extremities.

Management of chronic swelling of the limbs is a continuing challenge to patients and clinicians. In recent years, there has been progress in diagnoses and treatment of this disabling condition. The goal of this present volume is to collect between two covers the best guidelines for treatment, followed by detailed descriptions of the most effective tests and modern treatments for the disabling condition best called chronic lymphedema.

Because of the nature of the abnormalities that cause lymphedema, there is no established cure. There are, however, many methods that, when used in their aggre­gate, can correct and ameliorate limb swelling. These methods provide guidelines and prescription for effective treatment. The stated objectives of this volume are to describe the guidelines for thorough diagnosis and effective treatment of patients with disabling lymphedema.

It is truly fortunate that, as we enter the twenty-first century, the fields of lymphatic biology and medicine are experiencing a highly anticipated renaissance. This much­needed emphasis upon the study of the lymphatic system is predicted to have a transformative impact upon our understanding of physiology, health, and disease.