Lymph Edema of the Arm After AV Access Surgery

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Department of Vascular Surgery, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany

Secondary lymph edema of the arm after AV access surgery is rare, but it seriously compromises a patient’s well-being.

13.1 Pathophysiology

Starting in the periphery, lymphatic capillaries, precollectors, and collectors converge into trunks. Beginning with precollectors, lymphatic vessels have valves, which determine the flow direction. Lymphatic fluid is propelled by contractions of the vessel walls, which follow a complex regulation as required. The lymphatic system of the arm resembles the venous system. It consists of a deep (subfascial) as well as a superficial system, which is interconnected by perforators. In the arm, the collectors of the deep lymphatic system follow the arteries. Those of the superficial system form three bundles (median, radial, and ulnar). In the upper arm there are three bundles (median, dorsolateral, and dorsomedial) as well. Collaterals interconnect collectors. A lymph edema occurs if the lymphatic load surpasses the transport capacity.

Lymph edema after AV accesses is caused by:

Transection of lymphatic vessels
Compression of lymphatic vessels (e.g., hematoma, lymphocele, or seroma)
Inflammatory changes of the lymphatic vessels
Decompensation of the lymphatic system (with venous congestion)

Postoperative lymph edemas are either temporary or chronic.

13.2 Postoperative Lymph Edemas

13.2.1 Local Lymph Edema

Local lymph edemas can often be found on the inside of a looped graft. They mostly appear in the volar forearm and ventral thigh, more rarely in the upper arm. They almost always recede within days or weeks, not requiring further treatment.

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