Innovations in lymphedema treatment

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( Image: Depositphotos)
( Image: Depositphotos)

Swelling of one or more limbs due to lymphedema affects one in five women undergoing breast cancer surgery following the operation. The CHUV is proposing two promising new methods to treat this condition.

The lymphatic network comprises vessels, nodes and organs that circulate and filter lymph - a biological fluid derived from blood - throughout the body. The lymphatic network is essential to the functioning of the immune system, protecting against infection by acting as a filter.

When lymphatic vessels are blocked or damaged, lymph fluid accumulates in the tissues and their quality gradually changes, leading to swelling, heaviness, pain and recurrent infections in the affected limb. This is known as lymphedema. At an advanced stage of the disease, limb mobility may even be impaired. These symptoms have a major impact on patients’ quality of life.

Lymphedema can appear spontaneously, or more often following a traumatic injury (usually surgery), a serious infection or after treatment for breast cancer, for example, which may have required removal of lymph nodes or a lymphatic passageway.

Microsurgical techniques to relieve patient suffering

Conservative treatments, such as manual lymphatic drainage by physiotherapists or the wearing of compression stockings, relieve affected limbs without treating the cause of the disease. A number of surgical treatments are also available at different stages of the disease to provide relief, in addition to conservative treatments.

The Plastic and Hand Surgery Department at the CHUV specializes in lymphatic reconstruction. In particular, lymphoveinous anastomoses enable lymphatic vessels to be sutured directly to small veins to promote the evacuation of lymph from tissues. Microsurgical and supramicrosurgical techniques even make it possible to suture tiny vessels (up to 0.5 mm in diameter).

For more advanced stages of the disease, lymph node transplantation delivers more effective results, as lymph nodes are transplanted into the weakened lymphatic area and connected - with the help of a microscope - to the arteries and veins of the affected limb in order to be revascularized. Supplied with blood, the lymph nodes act like sponges, evacuating lymph while producing vascular growth factors that will recreate a new lymphatic network", explains Pietro Di Summa, associate professor at UNIL, assistant physician and surgeon in the Plastic and Hand Surgery Department at CHUV. Laparoscopic harvesting of lymph nodes around the stomach is a minimally invasive technique which, thanks to a small incision, reduces the opening of the abdomen, thereby reducing the risk of surgical complications and promoting rapid recovery’, explains Dr. Emilie Uldry, associate physician and surgeon in the Department of Visceral Surgery, privat-doctor at UNIL.

World first: CHUV tests an implantable artificial lymphatic vessel

The CHUV’s Angiology Department, which specializes in the care of patients with disorders of the veins, arteries, lymphatic vessels and microcirculation, is currently conducting the Lymphopilot clinical study to assess the safety and feasibility of a new implantable device to relieve and treat lymphedema. The study was carried out on women with lymphedema in one arm following breast cancer surgery.

It’s a device implanted under the skin, a sort of artificial drain with a hole in it, which works in place of the damaged or absent lymphatic vessel, draining the lymph thanks to a small automatic pump operated from the outside," explains Lucia Mazzolai, Professor at UNIL and Head of the Heart and Vessels Department at CHUV. This light, painless medical device, implanted in the arm, provides daily relief for lymphedema sufferers. ’

The study started in June 2021 and will finish in October with very good preliminary results, which were presented at the European Congress of Vascular Medicine in Milan in mid-October. ’ Demonstrating the safety of the device through this first clinical study was the first step we needed to take. We can now start the study that will validate the device’s efficacy and apply it to different types of lymphedema", enthuses Lucia Mazzolai.