Rheumatoid Lymphedema Successfully Treated with Lymphaticovenular Anastomosis: A Case Report
06 November 2018
19 January 2019
08 May 2019 (online)
Background A 76-year-old woman presented with rheumatoid lymphedema (RL) distal to the left elbow after 20 years of affliction with rheumatoid arthritis (RA). Although the RA was controlled by medication, the patient could not receive full-scale compression therapy for her edema with a medium-pressure compression sleeve (pressure: 20–25 mm Hg) due to hand dysfunction caused by long-term RA.
Methods Lymphaticovenular anastomosis (LVA) was performed after compression therapy with a low-pressure sleeve (14–18 mm Hg) proved ineffective for edema relief. Two anastomoses were created in a side-to-end fashion at the cubital fossa.
Results The edema improved rapidly after LVA and was maintained with a low-pressure compression sleeve.
Conclusion LVA represents a treatment option for remaining RL in RA treatment. As some RL patients are ineligible for full-scale compression therapy due to hand dysfunction caused by RA, LVA may help to reduce RL and enable edema management using a low-pressure compression garment without concern for hand dysfunction.
The authors have nothing to disclose.
- 1 Nguyen TT, Hoskin TL, Habermann EB, Cheville AL, Boughey JC. Breast cancer-related lymphedema risk is related to multidisciplinary treatment and not surgery alone: Results from a large cohort study. Ann Surg Oncol 2017; 24 (10) 2972-2980
- 2 Badger CM, Peacock JL, Mortimer PS. A randomized, controlled, parallel-group clinical trial comparing multilayer bandaging followed by hosiery versus hosiery alone in the treatment of patients with lymphedema of the limb. Cancer 2000; 88 (12) 2832-2837
- 3 Basta MN, Gao LL, Wu LC. Operative treatment of peripheral lymphedema: a systematic meta-analysis of the efficacy and safety of lymphovenous microsurgery and tissue transplantation. Plast Reconstr Surg 2014; 133 (04) 905-913
- 4 Kalliomäki JL, Vastamäki M. Chronic diffuse oedema of the rheumatoid hand: a sign of local lymphatic involvement. Ann Rheum Dis 1968; 27 (02) 167-169
- 5 Ostrov BE. Beneficial effect of etanercept on rheumatoid lymphedema. Arthritis Rheum 2001; 44 (01) 240-241
- 6 Eyigor S, Karapolat H, Kirazli Y. Efficacy of etanercept and complete decongestive physical therapy in bilateral lower-limb lymphoedema associated with rheumatoid arthritis: a case report. Adv Ther 2008; 25 (01) 23-28
- 7 Kogure T, Hoshino A, Ito K. , et al. Beneficial effect of complementary alternative medicine on lymphedema with rheumatoid arthritis. Mod Rheumatol 2005; 15 (06) 445-449
- 8 Lansbury J. Report of a three-year study on the systemic and articular indexes in rheumatoid arthritis; theoretic and clinical considerations. Arthritis Rheum 1958; 1 (06) 505-522
- 9 Yasunaga Y, Yanagisawa D, Ohata E, Matsuo K, Yuzuriha S. Bioelectrical impedance analysis of water reduction in lower-limb lymphedema by lymphaticovenular anastomosis. J Reconstr Microsurg 2018 Doi: 10.1055/s-0038-1675368
- 10 International Society of Lymphology. The diagnosis and treatment of peripheral lymphedema: 2013 Consensus Document of the International Society of Lymphology. Lymphology 2013; 46 (01) 1-11
- 11 International Lymphoedema Framework. International Consensus: Best Practice for the Management of Lymphoedema. London: MEP Ltd.; 2006
- 12 Yamamoto T, Yamamoto N, Doi K. , et al. Indocyanine green-enhanced lymphography for upper extremity lymphedema: a novel severity staging system using dermal backflow patterns. Plast Reconstr Surg 2011; 128 (04) 941-947
- 13 Mihara M, Hara H, Hayashi Y. , et al. Pathological steps of cancer-related lymphedema: histological changes in the collecting lymphatic vessels after lymphadenectomy. PLoS One 2012; 7 (07) e41126
- 14 Kuroyanagi G, Yamada K, Imaizumi T. , et al. Leg lymphedema caused by iliopectineal bursitis associated with destruction of a rheumatoid hip joint: A case report. Exp Ther Med 2013; 6 (04) 887-890
- 15 Nagai Y, Aoyama K, Endo Y, Ishikawa O. Lymphedema of the extremities developed as the initial manifestation of rheumatoid arthritis. Eur J Dermatol 2007; 17 (02) 175-176
- 16 Maegawa J, Yabuki Y, Tomoeda H, Hosono M, Yasumura K. Outcomes of lymphaticovenous side-to-end anastomosis in peripheral lymphedema. J Vasc Surg 2012; 55 (03) 753-760
- 17 Campisi CC, Ryan M, Boccardo F, Campisi C. A single-site technique of multiple lymphatic-venous anastomoses for the treatment of peripheral lymphedema: long-term clinical outcome. J Reconstr Microsurg 2016; 32 (01) 42-49