Lower limb gigantism, lymphedema, and painful varicosities following a thigh vascular access graft

Abstract

Prosthetic arteriovenous grafts (AVGs) are associated with greater morbidity than autogenous arteriovenous fistulas (AVFs), but their use is indicated when AVF formation is not possible. This report adds to the literature a case of lower limb gigantism, painful varicosities, and lymphedema following long-term use of AVG in the upper thigh. The patient's past medical history included renal transplantation on the same side well before the AVG was inserted and right leg deep vein thrombosis. Suspicion of AVG thrombosis was excluded by Doppler ultrasound, which demonstrated an access flow of 1700 mL/min. A computed tomography (CT) scan of the abdomen and pelvis did not identify the cause of her symptoms. Whereas functional incompetence of the iliac vein valve might be responsible for the varicosities, the extent of hypertrophy in this case raises the suspicion of lymphatic blockage possibly secondary to groin dissection undertaken at the time of graft insertion, in addition to the previous dissection at the time of transplantation. This case highlights the need for minimal groin dissection during AVG insertion, particularly in patients with a history of previous abdominopelvic surgery.

Chronic lymphedema reversal following arteriovenous fistula takedown: A case report

“…Thompson et al reported a case of 62 years lady with a right lower limb swelling and painful varicosities with an arteriovenous graft for hemodialysis 5 years back. All the complications were ruled out and it was confirmed to be a case of lymphedema [ 10 ]. The case was managed conservatively because of decreased eGFR with the requirement of dialysis in the future.…”

Symptom Frequency, Intensity, and Distress in Patients with Lower Limb Lymphedema

“…19 Secondary lower limb lymphedema may also occur due to trauma, 6,20 or following a surgical procedure. 21 Some patient-reported outcome measures have been used to understand the impact of lower limb lymphedema on patients physical and psychosocial functioning. Examples of these measures include the Lymphoedema Quality-of-Life (LYM-QOL) Study Survey, 22 the European Organization for Research and Treatment of Cancer (EORTC) Survey, 23 and the Symptom Distress Scale.…”