Bioimpedance Analysis for Predicting Outcomes of Complex Decongestive Therapy for Gynecological Cancer Related Lymphedema: A Feasibility Study

Decompression of Axillary Vein: An Essential Adjunct for Advanced Lymphedema

BACKGROUND

In advanced lymphedema, lymphovenous anastomosis (LVA) can be a solution based on using the pressure gradient between the high-pressure lymphatics and the low-pressure veins. If the vein pressure is high, the effect of surgery will be less optimal. This study evaluated the effect of axillary vein perivascular scar release on LVA.

METHODS

This is a retrospective study of 40 upper limb stage 2 and 3 lymphedema patients divided into 2 groups with an average follow-up of 33 months (minimum of at least 12 months): the scar release group ( n = 25) and the control group ( n = 15). All patients underwent LVA with or without lymph node transfer. Demographic data, outcome (volumetric change and bioimpedence analysis [BIA]), and major vein (axillary, basilic, and cephalic) diameter changes were evaluated.

RESULTS

Both groups showed significant reduction in volume and BIA parameters after LVA. The scar release group (24 of 25 with lymph node transfer and 1 without) showed statistically higher reduction of BIA analysis compared with the control group at 1, 6, and 12 months after LVA. The changes in the major veins after axilla scar release showed significant changes in all 3 veins. There was a significant correlation between cephalic vein diameter reduction and BIA measurement.

CONCLUSIONS

The release of perivascular scar in the axillary vein may result in better outcome after LVA. This is based on the finding that scar release shows correlation between cephalic vein diameter reduction and BIA measurement suggesting reduction of venous pressure in the peripheral vein increasing the pressure gradient between the lymphatic and venous system allowing better outflow after LVA.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, III.

Lymphedema Index Ratio As Predictive Factor of Treatment in Patients with Breast Cancer-Related Lymphedema

Background: This retrospective observational study aimed to evaluate the lymphedema index ratio to predict the effect of complex decongestive therapy (CDT) in patients with breast cancer-related lymphedema (BCRL) and to establish a lymphedema index ratio cutoff value for the extent of CDT effect. Materials and Methods: All 108 enrolled patients with BCRL underwent volume measurements and bioelectrical impedance analysis before and after CDT. The difference in percent excess volume (PEV) before and after CDT was defined as the therapeutic effect, and each patient was assigned to Groups A, B, or C based on therapeutic effects of 0%-5%, 5%-10%, and 10%-20%, respectively. Results: The mean lymphedema index ratios of Groups A, B, and C were 1.27, 1.38, and 1.46, respectively, with significant differences between the groups (p < 0.01). The cutoff lymphedema index ratio values for diagnosis between Groups A and B and between Groups B and C were 1.277 (sensitivity: 71.7%, specificity: 61.8%) and 1.357 (sensitivity: 76.9%, specificity: 62.1%), respectively. The Spearman coefficients for the linear relationship between lymphedema index ratio and initial PEV and between lymphedema index ratio and therapeutic effect were found to be significant at 0.615 and 0.360, respectively (p < 0.01). Conclusion: The results of this study found that the lymphedema index ratio may predict the volume reduction in patients with BCRL. A less reduction (therapeutic effect <5%) was predicted in patients with a lymphedema index ratio of <1.277, while a greater reduction (therapeutic effect >10%) was predicted in patients with a lymphedema index ratio of >1.357.