Lymphatic Injury and Peripheral Lymphedema as Complications of Central Venous Catheter: A Case Report and a Literature Review
International Research Journal of Oncology,
Introduction: Secondary lymphedema is defined as a chronic-progressive disease which causes a rich protein edema of the limbs, this may be caused due to the damage or obstruction of lymphatic structures; secondary peripheral lymphedema may be considered a complication of central venous catheter procedures.
Objective: To describe a clinical case of upper extremity lymphedema as venous port catheter related complication and present a review of literature of lymphatic complications of central venous catheter.
Case Presentation: A 57-year-old woman received previous medical attention between 2019-2020 due to Hodgkin lymphoma; the patient was diagnosed by left cervical lymph node biopsy and received 12 chemotherapy cycles through right subclavian catheter. The patient arrived to our facilities in March 2021 to assess her case due to increased right arm volume related to progressive edema that did not improve with rest or elevation and began to limit movements and basic activities; the situation began after a previous right catheter infection and a change of it in January 2020 with no evidence of venous thrombosis and identified a worsening tendency with time since last chemotherapy in May 2020. After clinical history, physical examination and ICG NIR lymphography study, lymphedema was confirmed as a result of subclavian catheter related complication. We decided to present the case along a literature review on the topic.
Conclusion: Lymphatic injury and peripheral lymphedema related to Central Venous Catheter procedures and its complications is a clinical reality that might be underrecognized and underdiagnosed by scientific literature and clinicians; this condition should be properly studied and deeply considered with the adequate assessment strategies in patients undergoing CVC procedures in the mid and long term to avoid its undertreatment.
- Peripheral lymphedema
- central venous catheter
- lymphatic injury
- lymphatic imaging
How to Cite
López Montoya, Luis. El linfedema Explicado. Tercera edición. Editorial Fenix. México. 2021;(1)1-8:41-45. ISBN: 975-607-96852-
López-Montoya LE, Pereira-de Godoy JM, Guerreiro-Godoy M, de F. Evolucióndistinta de linfedema primarioetapa II de miembrosinferiores. Revista de la Facultad de Medicina. 2019;67(3):547-549. Available:https://doi.org/10.15446/revfacmed.v67n3.66099
Bowman C, Piedalue K-A, Baydoun M, Carlson LE. The quality of life and psychosocial implications of cancer-related lower-extremity lymphedema: A systematic review of the literature. Journal of Clinical Medicine. 2020;9(10):3200. DOI: 10.3390/jcm9103200
Boyages J, Xu Y, Kalfa S, Koelmeyer L, Parkinson B, Mackie H, Viveros H, Gollan P, Taksa L. Financial cost of lymphedema borne by women with breast cancer. Psycho-oncology. 2017;26(6):849–855. Available:https://doi.org/10.1002/pon.4239
Greene Arin. Epidemiology and Morbidity of Lymphedema. Lymphedema: Presentation, Diagnosis, and Treatment. 2015;33-44. Available:https//doi.org/10.1007/978-3-319-14493-1_4
Kayıran O, De La Cruz C, Tane K, Soran A. Lymphedema: From diagnosis to treatment. Turkish Journal Of Surgery. 2017;33(2):51–57. Available:https://doi.org/10.5152/turkjsurg.2017.3870
Sleigh BC, Manna B. Lymphedema. In Stat Pearls. Stat Pearls Publishing; 2021. PMID: 30725924
Mehrara BJ, Greene AK. Lymphedema and obesity: is there a link?. Plastic and reconstructive surgery. 2014;134(1):154e–160e. Available:https://doi.org/10.1097/PRS.0000000000000268
Bunke N, Brown K, Bergan J. Phlebolymphemeda: usually unrecognized, often poorly treated. Perspectives in vascular surgery and endovascular therapy, 2009;21(2):65–68. Available:https://doi.org/10.1177/1531003509337155
Scharff RP, Recto MR, Austin EH 3rd, Wilkerson SA. Lymphocutaneous fistula as a long-term complication of multiple central venous catheter placement. Texas Heart Institute Journal. 2000;27(1):57–60. PMCID: PMC101022
Lv S, Wang Q, Zhao W, Han L, Wang Q, Batchu N, Ulain Q, Zou J, Sun C, Du J, Song Q, Li, Q. A review of the postoperative lymphatic leakage. Oncotarget. 2017;8(40):69062-69075. Available:https://doi.org/10.18632/oncotarget.17297
Ruchan A, Deniz A, Ali C. Port catheter complications and thrombosis issues: assessment of 114 patients with port catheter implantation by single surgeon. Biomedical Research and Therapy. 2017;4(12):1898-1910. Available:https://doi.org/10.15419/bmrat.v4i12.401
Kylat RI, Kuo PH, Bedrick AD, Witte MH. Neonatal Lymphedema from Thoracic Duct Obstruction Complicating Percutaneous Intravenous Central Catheterization. Lymphology. 2017;50(2):67–72. PMID: 30234243.
Turfe Z, Pettinga J, Leduc O, Leduc A, Komorowska-Timek E. Chemotherapy port related lymphedema after axillary lymph node dissection. Breast (Edinburgh, Scotland). 2016;28:145–147. Available:https://doi.org/10.1016/j.breast.2016.05.008
Wright RS, Quinones-Baldrich WJ, Anders AJ, Danovitch GM. Pleural effusion associated with ipsilateral breast and arm edema as a complication of subclavian vein catheterization and arteriovenous fistula formation for hemodialysis. Chest. 1994;106(3):950–952. Available:https://doi.org/10.1378/chest.106.3.950
Sarmast H, Takriti A. Yellow nail syndrome resulting from cardiac mitral valve replacement. Journal of Cardiothoracic Surgery. 2019;14. DOI: 10.1186/s13019-019-0903-1
Pan Wei-Ren. Atlas of Lymphatic Anatomy in the Head, Neck, Chest and Limbs. Springer, Singapore. 2015;6(1,2): 98. Available:https://doi.org/10.1007/978-981-10-3749-8
Amore M, Tapia L, Mercado D, Pattarone G, Ciucci J. Lymphedema: A general outline of its anatomical base. Journal of Reconstructive Microsurgery. 2016;32(1): 2–9. https://doi.org/10.1055/s-0035-1560038
Gibson F, Bodenham A. Misplaced central venous catheters: applied anatomy and practical management. British Journal of Anaesthesia. 2013;110(3):333–346. Available:https://doi.org/10.1093/bja/aes497
Stolarz AJ, Sarimollaoglu M, Marecki JC, Fletcher TW, Galanzha EI, Rhee SW, Zharov VP, Klimberg VS, Rusch, NJ. Doxorubicin activates ryanodine receptors in rat lymphatic muscle cells to attenuate rhythmic contractions and lymph flow. The Journal of Pharmacology and Experimental Therapeutics. 2019;371(2):278–289. Available:https://doi.org/10.1124/jpet.119.257592
Kornbau C, Lee KC, Hughes GD, Firstenberg MS. Central line complications. International Journal of Critical Illness and Injury Science. 2015;5(3):170–178. Available:https://doi.org/10.4103/2229-5151.164940
O'Donnell TF, Jr Rasmussen JC, Sevick-Muraca EM. New diagnostic modalities in the evaluation of lymphedema. Journal of Vascular Surgery. Venous and Lymphatic Disorders. 2017;5(2):261–273. Available:https://doi.org/10.1016/j.jvsv.2016.10.083
Montoya PTLL, Valadez MDLRG, López PTY, Sandoval PTJ, Montoya PTAL, Alcaraz PTI, Paz PTC. Development and feasibility of a very low-cost, home-made, near infrared lymphatic imaging device. Journal of Advances in Medicine and Medical Research. 2020;32(22):59- 65. Available:https://doi.org/10.9734/jammr/2020/v32i2230706
Suami H, Heydon-White A, Mackie H, Czerniec S, Koelmeyer L, Boyages J. A new indocyanine green fluorescence lymphography protocol for identification of the lymphatic drainage pathway for patients with breast cancer-related lymphoedema. BMC Cancer. 2019;19(1):985. Available:https://doi.org/10.1186/s12885-019-6192-1
Narushima M, Yamamoto T, Ogata F, Yoshimatsu H, Mihara M, Koshima, I. Indocyanine green lymphography findings in limb lymphedema. Journal of Reconstructive Microsurgery. 2016; 32(1):72–79. Available:https://doi.org/10.1055/s-0035-1564608
Farias-Cisneros E, Chilton PM, Palazzo MD, Ozyurekoglu T, Hoying JB, Williams SK, Baughman C, Jones CM, Kaufman CL. Infrared imaging of lymphatic function in the upper extremity of normal controls and hand transplant recipients via subcutaneous indocyanine green injection. SAGE Open Medicine. 2019;7:2050312119862670. Available:https://doi.org/10.1177/2050312119862670
Yamamoto T. Comprehensive Lymphedema Evaluation Using Dynamic ICG Lymphography. In: Kusano M, Kokudo N, Toi M, Kaibori M. (eds) ICG Fluorescence Imaging and Navigation Surgery. Springer, Tokyo; 2016. Available:https://doi.org/10.1007/978-4-431-55528-5_41
Seo TS, Song MG, Kang EY, Lee CH, Yong HS, Doo K. A single-incision technique for placement of implantable venous access ports via the axillary vein. Journal of Vascular and Interventional Radiology: JVIR. 2014;25(9):1439– 1446. Available:https://doi.org/10.1016/j.jvir.2013.12.571
Isom C, Bream P Jr, Gallagher K, Walia S, Ahmed R, Kauffmann R. Placement of Subcutaneous Central Venous Ports in Breast Cancer Patients: Does Side Matter? J Surg Res. 2019;244:296- 301. DOI:10.1016/j.jss.2019.06.028. Epub 2019 Jul 11. PMID: 31302328.
Böll B, Schalk E, Buchheidt D, et al. Central venous catheter–related infections in hematology and oncology: 2020 updated guidelines on diagnosis, management, and prevention by the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO). Ann Hematol. 2021;100:239–259. Available:https://doi.org/10.1007/s00277-020-04286-x
Abstract View: 347 times
PDF Download: 176 times