Lymphatic damage in venous surgery

Purpose: Before a lower limb surgical operation due to venous disease, it is necessary to immediately evaluate the presence and seriousness of the concurrent lymphatic deficiency. Methods: Besides objective test that can reveal a clinically evident lymphatic deficiency, it is helpful to investigate family and remote pathological anamnesis to identify possible risk factors or specific family propensities. As far as instrumental tests are concerned, it is advisable to perform both a doppler ultrasonographic examination and a limb segmentary Lymphoscintigraphy. The most risky area is the inguinal one, where lymphatic collector vessels join main lymph-nodal structures. Obviously, lesions of these structures may start a lymphatic deficiency, but it is also important to underline that scar reactions and relevant fibrosis, that may characterize an even normal post-operation period, may create a further obstacle to normal lymphatic drain. Results and Conclusions: Special attention has to be paid to precise indications and venous surgery technique in mixed clinical situations, when both venous and lymphatic systems are involved, to avoid potential clinical state worsening. Finally, diagnostic and therapeutical prevention modalities for possible lymphatic injuries in CVI affected limbs have to be kept into consideration, up to microsurgical technique application. Hopefully therefore, with the purpose of a correct preventive and not invasive surgical operation, more an more attention will be paid regarding potential lymphatic impairment derived from venous surgery.