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AXILLARY VEIN COMPRESSION TEST
BELGRADO J.-P. 1, VANDERMEEREN L. 2, VANKERCKHOVE S. 2, VALSAMIS J.-B. 1, MORAINE J.-J. 1, LIEBENS F. 2
1 Université Libre de Bruxelles - Lymphology Research Unit, Bruxelles, Belgium 2 C.H.U. St-Pierre - Lymphology clinic of Brussels, Belgium
Introduction: Total adenectomy of the axilla has not only consequences on the lymph flow, but also on other biomechanical functions: modifications of the axillary vein’s hemodynamic can be involved in the pathophysiology of secondary breast cancer lymphedema.
The gold standard examination, echodoppler, is time consuming and needs a specific protocol to confirm the orthostatic intermittent stenosis of the vein.
We have developed a fast and specific provocation test in order to highlight a possible participation of the vein in the genesis of edema.
Method: 42 patients affected by unilateral secondary breast cancer lymphedema stage I or IIa have underwent our provocation test. During the execution of the test, the examiner is behind the patient; the concerned upper limb is held passively in antepulsion of 90° (reference position); the color of the dorsum of the hand is memorized; then, the arm is placed by the examiner vertically along the trunk, adding manually a sagittal and medial compression on the root of the limb during 15 seconds. If the hand really reddens, the test is positive.
In order to study the test, we started with a qualitative and a semi-quantitative observation. For the qualitative part, we asked an innocent bystander to appraise the change of the hand’s color during the test on both arms. For the semi-quantitative part, we took a picture of the hand in standardized conditions at both steps (reference position and vertical position).
With the help of software ImageJ we filtered RGB colors maintaining only the red pixels. Then the histogram of step 1 and 2 were compared.
Results: The axillary vein provocation test is easy to apply by a single examiner in the clinic routine; it takes only 30 seconds. The correlation between the qualitative and semi-quantitative test is effective (r=0, 92, p<0,001)
Provoking a “prolonged” compression of the axillary vein, in pathological conditions aggravates the intermittent phenomenon that is expressed by an increase of the skin’s redness because of an increased pressure in the distal microcirculation.
Conclusion: All patients were submitted to our axillary vein compression test. Patients with positive test present an impairement of the axillary vein’s hemodynamic, inducing rapid hand’s redness. This study confirmed good correlation between the visual qualitative method and a semi-quantitative method to assess hand’s redness. In conclusion, we propose here a simple and rapid axillary vein compression test to screen patients with impairement of the axillary vein’s hemodynamic, which may be validated directly by visual observation.
LYMPHEDEMA PATIENTS’ SELF-TREATMENTS: PSYCHOSOCIAL ASPECTS
1 Dept. of Gynaecology and Obstetrics / University Hospital Brno, Czech Republic
2 Institute of Psychology and Psychosomatics Medical faculty/ Masaryk university, Brno, Czech Republic 3 Dept. of Radiology/ University Hospital, Brno, Czech Republic
BENDOVA M.1, SKRIVANOVA K.2, BENDA K.3
Lymphedema management is based on complex decongestive therapy (CDT) and complementary therapeutical procedures as surgery, pharmacotherapy, psychotherapy and self treatment. Pts’ self-treatment includes: skin care, self-lymphdrainage, self-bandaging, self- applied pneumatic copression, elevation of the limbs, supporting physical and breathing exercises, appropriate recreational and sport activities, arrangements in life régime and self-measurements. Our study is based on experience from in general 648 pts. suffering from chronic lymphedema, treated in ARCUS onco- lymphocentre who underwent CDT according individual planning, including educational seminars (self-treatment, life régime, nourishment, supportive physical exercises). To all pts. self-treatment was recommended after clear enough instructions. Collected knowledge evoked consequentional cognitions concerning psychological factors influencing pts’ self-treatment. They are:
a/ Basic psychological factors determining effective self-treatment:
– appropriate pts’ information about lymphedema pathofysiology end essential treatment procedures (CDT),
– individual self-treatment planning according to pt’s age, physical and psychical limitations, manual ability, neccessity of
somebody else’s help etc.),
– awarness of regular checking and controle of pt’s compliance, physical state and psychic condition.
b/ Psychological impact on active self-treatment and to CDT effectiveness:
– strenght of pt’s compliance and active participation in CDT,
– strenght of pt’s awarness of personal responsibility for treatment outcome,
– strenght of pt’s activity, self-assurance, self-confidence and prevention of possible psychic disorders (discomfort, disappointment,
depression, anxiety, care-ignorance etc),
– benefit of feasibility at home (everywhere).
Conclusion: Self-treatment represents unavoidable part of CDT. Knowledge of influencing psychological factors improves effectiveness of this procedure.
This study was supported by grant P 407/12/O6O2 of the Grant Agency of the Czech Republic
THE EUROPEAN JOURNAL OF LYMPHOLOGY - Vol. XXVI - Nr. 72 - 2015
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