Treatment strategies and clinical aspects of lower limb edema following peripheral bypass surgery

In selected patients who suffer from severe peripheral artery disease (PAD) a revascularization with a peripheral bypass might be considered. Postoperative edema is a well-known phenomenon following peripheral bypass surgery and is probably caused by multiple factors. Although postoperative edema causes discomfort to patients, the effects on the quality of life are unknown. Treatment and preventive strategies should nonetheless aim at achieving a net absorption of fluid from the interstitial space into the vascular or lymphatic compartment. A brief summarization of treatment strategies of lower limb edema will be presented that include the use of compression stocking and intermittent pneumatic compression. So far, the postoperative application of compression stockings seem to prevent and reduce edema as much as possible. Quality of life improves slightly following peripheral bypass surgery. However, a contribution of edema on the quality of life could not be detected.

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Pathophysiology and treatment of edema following femoropopliteal bypass surgery

Vascular ◽

10.1258/vasc.2011.ra0055 ◽

2012 ◽

Vol 20 (6) ◽

pp. 350-359

Author(s):

A Te Slaa ◽

D E J G J Dolmans ◽

G H Ho ◽

F L Moll ◽

L Van Der Laan

Keyword(s):

Bypass Surgery ◽

Treatment Strategies ◽

Cochrane Library ◽

Compression Stockings ◽

External Compression ◽

Peripheral Bypass ◽

Limb Edema ◽

Antioxidative Therapy ◽

The Cochrane Library ◽

Invasive Techniques

Substantial lower-limb edema affects the majority of patients who undergo peripheral bypass surgery. Edema has impairing effects on the microvascular and the macrovascular circulation, causes discomfort and might delay the rehabilitation process of the patient. However, the pathophysiology of this edema is not well understood. The Cochrane Library and Medline were used to retrieve literature on edema following peripheral bypass surgery. Factors other than local wound healing alone are suggested in the literature to play a role, given the severity and duration of this edema. Hyperemia, microvascular permeability, reperfusion-associated inflammation and lymphatic disruptions are likely to facilitate the development of edema. Preventive methods could be lymphatic-sparing surgery, intraoperative antioxidative therapy and postoperative elevation. Successful treatment strategies to reduce postoperative edema are based on lymph massage and external compression. In conclusion, the pathophysiology of edema following peripheral surgery is not fully understood, although reperfusion-associated inflammation and lymphatic disruptions are likely to play a crucial role. When future less-invasive techniques prove to be successful, postoperative edema might be minimized. Until then, a careful lymphatic-sparing dissection should be executed when performing a peripheral bypass reconstruction. Postoperatively, the use of compression stockings and leg elevation are currently the golden standards.

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THE LONG-TERM QUALITY OF LIFE IN PATIENTS WITH PERIPHERAL ARTERIAL DISEASE AFTER PERIPHERAL BYPASS SURGERY

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(10)61459-3 ◽

2010 ◽

Vol 55 (10) ◽

pp. A156.E1458 ◽

Cited By ~ 1

Author(s):

Eline S. Van Hattum ◽

Marco J. Tangelder ◽

James A. Lawson ◽

Frans L. Moll ◽

Ale Algra

Keyword(s):

Quality Of Life ◽

Peripheral Arterial Disease ◽

Bypass Surgery ◽

Arterial Disease ◽

Peripheral Bypass ◽

Peripheral Arterial

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Effects of Intermittent Pneumatic Compression on Lower Limb Edema and Health-Related Quality of Life in Breast Cancer Patients Undergoing Adjuvant Chemotherapy

International Journal of Nursing & Clinical Practices ◽

10.15344/2394-4978/2018/285 ◽

2018 ◽

Vol 5 (1) ◽

Author(s):

Chie Furukawa ◽

Takashi Morimoto ◽

Ikuharu Morioka

Keyword(s):

Breast Cancer ◽

Quality Of Life ◽

Lower Limb ◽

Intermittent Pneumatic Compression ◽

Health Related Quality ◽

Breast Cancer Patients ◽

Limb Edema ◽

Related Quality ◽

Health Related

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Impact of compression stockings on calf-vein diameters and on quality of life parameters in subjects with painful legs

VASA ◽

10.1024/0301-1526/a000362 ◽

2014 ◽

Vol 43 (4) ◽

pp. 268-277 ◽

Cited By ~ 8

Author(s):

Christina Jeanneret ◽

Konstantinos Karatolios ◽

Irene von Planta

Keyword(s):

Quality Of Life ◽

Standing Position ◽

Life Assessment ◽

Compression Stocking ◽

Compression Stockings ◽

Cross Sectional ◽

Assessment Scores ◽

Sectional Plane ◽

Calf Vein

Background: Calf vein diameters during compression with two different stocking brands are assessed as well as quality of life. Patients and methods: 60 subjects (53 female) with painful legs were randomized to either wearing the Venotrain micro® (VM) or the Venotrain ulcertec® (VU) compression stocking for 2 weeks. All calf - veins were assessed in cross - sectional plane by Duplexsonography native and through the compression stockings. The diameters of 2 gastrocnemius muscle - veins (GV), the short saphenous vein (SSV) and the posterior tibial vein (PTV) were compared intra - individually, with and without compression. Results: Mean diameters (± SD) decreased significantly under compression (p < 0.0001) in the standing position: in the antero-posterior (ap) plane of the GV by 6.5 (± 16.6) % under VU and 8.2 (± 16.5) % under VM, in the SSV 9.7 (± 15.8) % under VU and 5.7 (± 19.2) % under VM. No significant change (p = 0.48) was seen in the PTV. In the prone position the relative ap - diameter changes in the medial GV were significantly smaller for the VM (37.5 ± 51.0 %) compared to the VU compression stocking (52.4 ± 51.8 %) (p = 0.016). The quality of life assessment scores improved significantly for the VU - and the VM - compression stocking. Venous diameters did not correlate with quality of life scores. Conclusions: Intra - individually tested the calf muscle vein diameters decrease under compression, more pronounced in the prone than in the standing position. In the ankle area the PTV does not decrease in standing subjects. Quality of life assessed increases for both compression stockings.

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Postoperative quality of life, satisfaction, and skin condition after varicose vein surgery

Phlebologie ◽

10.12687/phleb2331-6-2016 ◽

2016 ◽

Vol 45 (06) ◽

pp. 363-369

Author(s):

G. Bruning ◽

A. Langenbruch ◽

M. Augustin ◽

W. Kath

Keyword(s):

Quality Of Life ◽

Varicose Veins ◽

Skin Condition ◽

Skin Care ◽

Surgical Removal ◽

Compression Stocking ◽

Free Text ◽

Compression Stockings ◽

Skin Moisture

SummaryCompression is performed postoperatively with the intention of minimising side effects, such as bleeding and haematoma in the area of operation, as well as postoperative oedema and pain. Compression stocking manufacturing has incorporated the addition of skin care products into the yarn material in recent years. However, the benefits of these products remain controversial. In addition, the length of the compression stocking is disputed in terms of its effectiveness. This effectiveness was investigated in the present study.Before surgery, 160 patients with indication of surgical removal of varicose veins were randomly divided into four groups with different types of compression stockings in each case. In each group, 40 patients received a knee-length stocking (length A–D), thigh-length stocking (length A–G), knee-length stocking with Aloe vera or thigh-length stocking with AV. At time 0 (before surgery), one week and 8 weeks after surgery, skin moisture was measured as an objective parameter, quality of life was determined using the Freiburger questionnaire of quality of life in veinous disease (FLQA-vs), benefit to patients was evaluated using the patient benefit index (PBI-v) and further subjective parameters were investigated with a free-text questionnaire. After surgery, the extent of haematoma was determined using the point count method.After surgery, at both post-operative times, the FLQA-vs decreased significantly (corresponding to a better quality of life), and the PBI-v increased. In the group with Aloe, pruritus was significantly lower, comfort and skin moisture were increased, and skin condition was significantly improved. The extent of haematoma decreased regardless of the length of the stockings.A benefit of AV as a skin care additive was observed. This finding was objectively confirmed based on the skin moisture. The multifactorial quality of life was not affected by the skin care additive. Thigh-length compression stockings did not provide a measurable benefit.

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Quality of Life in Perspective to Treatment of Postoperative Edema After Peripheral Bypass Surgery

Annals of Vascular Surgery ◽

10.1016/j.avsg.2011.07.012 ◽

2012 ◽

Vol 26 (3) ◽

pp. 373-382 ◽

Cited By ~ 8

Author(s):

Çiğdem Öztürk ◽

Alexander te Slaa ◽

Dennis E.J.G.J. Dolmans ◽

G.H. Ho ◽

Jolanda de Vries ◽

...

Keyword(s):

Quality Of Life ◽

Bypass Surgery ◽

Peripheral Bypass

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The quality of life in patients after peripheral bypass surgery deteriorates at long-term follow-up

Journal of Vascular Surgery ◽

10.1016/j.jvs.2010.09.021 ◽

2011 ◽

Vol 53 (3) ◽

pp. 643-650 ◽

Cited By ~ 14

Author(s):

Eline S. van Hattum ◽

Marco J.D. Tangelder ◽

James A. Lawson ◽

Frans L. Moll ◽

Ale Algra

Keyword(s):

Quality Of Life ◽

Bypass Surgery ◽

Peripheral Bypass ◽

Long Term Follow Up

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Hadrontherapy Interactions in Molecular and Cellular Biology

International Journal of Molecular Sciences ◽

10.3390/ijms21010133 ◽

2019 ◽

Vol 21 (1) ◽

pp. 133 ◽

Cited By ~ 3

Author(s):

Juliette Thariat ◽

Samuel Valable ◽

Carine Laurent ◽

Siamak Haghdoost ◽

Elodie A. Pérès ◽

...

Keyword(s):

Quality Of Life ◽

Tumor Volume ◽

Combined Treatment ◽

Treatment Strategies ◽

Particle Therapy ◽

Cellular Biology ◽

Clinical Aspects ◽

Direct Irradiation ◽

Accelerated Particles

The resistance of cancer cells to radiotherapy is a major issue in the curative treatment of cancer patients. This resistance can be intrinsic or acquired after irradiation and has various definitions, depending on the endpoint that is chosen in assessing the response to radiation. This phenomenon might be strengthened by the radiosensitivity of surrounding healthy tissues. Sensitive organs near the tumor that is to be treated can be affected by direct irradiation or experience nontargeted reactions, leading to early or late effects that disrupt the quality of life of patients. For several decades, new modalities of irradiation that involve accelerated particles have been available, such as proton therapy and carbon therapy, raising the possibility of specifically targeting the tumor volume. The goal of this review is to examine the up-to-date radiobiological and clinical aspects of hadrontherapy, a discipline that is maturing, with promising applications. We first describe the physical and biological advantages of particles and their application in cancer treatment. The contribution of the microenvironment and surrounding healthy tissues to tumor radioresistance is then discussed, in relation to imaging and accurate visualization of potentially resistant hypoxic areas using dedicated markers, to identify patients and tumors that could benefit from hadrontherapy over conventional irradiation. Finally, we consider combined treatment strategies to improve the particle therapy of radioresistant cancers.

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