Innovations at the CHUV in the treatment of lymphoedema

Swelling of one or more limbs as a result of lymphoedema – a common but little-understood condition – affects one in five women undergoing breast cancer surgery following the operation. The CHUV is offering two promising new methods for treating this condition.

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

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

Lymphoedema can occur spontaneously or, more often, as a result of a traumatic injury (usually surgery), a serious infection or after treatment for breast cancer, for example, where lymph nodes or a lymphatic passageway have had to be removed.

Microsurgical techniques to relieve patients

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

The Department of Plastic and Hand Surgery at the CHUV specialises in lymphatic reconstruction. In particular, lymphoveinous anastomoses allow lymphatic vessels to be sutured directly to small veins to promote the evacuation of lymph from tissues. Microsurgery and supramicrosurgery 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 provides more effective results, as the lymph nodes are transplanted into the weakened lymphatic zone and connected – with the help of a microscope – to the arteries and veins of the affected limb in order to be revascularised. “Supplied with blood, the lymph nodes act like sponges and evacuate the lymph while producing vascular growth factors that will recreate a new lymphatic network,” explains Prof. Pietro Di Summa, assistant physician and surgeon in the Department of Plastic and Hand Surgery at the CHUV. “Laparoscopic harvesting of the lymph nodes around the stomach is a minimally invasive technique that uses a small incision to reduce 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.

World first: CHUV tests an implantable artificial lymphatic vessel

The CHUV’s Angiology Department, which specialises in treating 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 for relieving and treating lymphoedema. The study was conducted on women who had lymphoedema 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 lymphatic vessel that is damaged or absent in the patient and drains the lymph using a small automatic pump operated from the outside,” explains Professor Lucia Mazzolai, Head of the Heart and Vessels Department at the CHUV. This medical device, implanted in the arm, is light and painless, and provides daily relief for people suffering from lymphoedema”.

The study started in June 2021 and will finish in October with very good preliminary results that 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 lymphoedema,” enthuses Prof Mazzolai.

Source: CHUV Press Release