Background. One of the main causes of operations of varicose veins remains pain and oedema of the affected extremity. Radical varicose vein operations, in some cases, do not eliminate oedema, especially in patients with preoperative lymphatic pathology. Among patients with mixed veno-lymphatic insufficiency, the use of lymphoscintigraphy seems to be reasonable for assessment of postoperative outcome. The theoretical possibility of lymphatic injury should also be considered during the varicose vein operation.
The aim of this paper is perioperative lymphoscintigraphic evaluation of lower extremities in patients with chronic venous insufficiency.
Material and methods. Between 2001 and 2004, in the Department of General and Vascular Surgery at Poznan University of Medical Sciences, 35 patients in stages C2-C5 CEAP of chronic venous insufficiency were qualified for radical varicose vein operation. The diagnosis and qualification were performed upon clinical examination and duplex Doppler ultrasound - reflux in greater saphenous vein of III/IV degree. In all patients enrolled to the study lymphoscintigraphy with nanocol+Tc 99m was performed. The time of appearance and the accumulation of administered agent after 60 and 120 minutes in the inguinal lymph node were assessed. In 15 patients, postoperative lymphoscintigraphy was performed within 16–24 months post-op. No recurrence of varicose veins or DVT incidence were observed.
Results. In all patients from group II and 8 patients from group I enrolled in the studies changes in the lymphatic system were observed, such as compensatory changes and I or II degree insufficiency. In postoperative lymphoscintigraphy, no worsening in lymphatic function was observed. After the operation, all patients showed the same type of lymphatic insufficiency as before the surgery. Varicose vein operation did not improve the function of the lymphatic system of the affected extremity.
Conclusions. Lymphoscintigraphy confirms the coexistence of lymphatic and venous pathology in patients with chronic venous insufficiency; in patients with oedemas, lymphoscintigraphy reveals significantly grater changes in comparison to patients with no oedema; radical varicose vein operation does not eliminate oedemas in patients with combined veno-lymphatic insufficiency.