S Vignes

Hôpital Européen Georges-Pompidou (Hôpitaux Universitaires Paris-Ouest), Paris, Ile-de-France, France

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Publications (163)121.85 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Objective: To analyze upper-limb lymphedema characteristics of renal transplant recipients taking sirolimus, an mTOR inhibitor. Method: Cross-sectional study of sirolimus-treated upper-limb lymphedema patients (01/2009-12/2013). Results: Three men and two women, whose mean age at transplantation was 60 (range: 49-76) years, were included. Sirolimus (1-2.5 mg/day) had been taken for 27.5±21 (range: 7-58) months before left (n=4) or right (n=1), whole limb (n=4), or hand and forearm (n=1) upper-limb lymphedema onset, always ipsilateral to the functional arteriovenous fistula. Ultrasonography or fistulography excluded venous thrombosis in all patients. At the time lymphedema appeared, all five arteriovenous fistulas were functional. Mean upper-limb lymphedema volume, calculated with the truncated-cone formula, was 774±162 [range: 594-1035] mL, (i.e. 44%±11% [range: 36%-64%] excess volume compared to the contralateral limb. One patient also had ipsilateral breast lymphedema. The three lymphoscintigraphies obtained showed total absence of ipsilateral axillary-region tracer uptake. Sirolimus was maintained in all cases. Upper-limb lymphedema treatment included low-stretch bandages (n=4) and elastic sleeve (20-36 mm Hg) (n=5) without fistula complications. Two patients had their fistulas closed without any impact on lymphedema volume. Conclusion: Sirolimus may be implicated in large-volume upper-limb lymphedema in kidney-transplant recipients, ipsilateral to the arteriovenous fistula, and requires compression-based therapy.
    Lymphatic Research and Biology 08/2014; · 2.33 Impact Factor
  • La Revue de Médecine Interne. 01/2014; 35(6):403–404.
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    ABSTRACT: Objectif Le traitement du lymphœdème repose sur la thérapie décongestive qui associe une phase initiale de traitement décongestif intensif (TDI) suivie d’un traitement d’entretien. L’objectif de l’étude POLIT était de décrire l’efficacité et la tolérance des traitements pendant la phase initiale et six mois après la phase de TDI. Méthodes Étude d’observation prospective multicentrique de patients présentant un lymphœdème unilatéral de membre. Objectif principal Évaluer la variation de volume du lymphœdème entre l’inclusion, la fin du TDI et après six mois de traitement d’entretien. Objectifs secondaires Évaluer la fréquence des lourdeurs handicapantes de membre et la tolérance des traitements ; déterminer des facteurs prédictifs de la variation de volume. Résultats Trois cent six patients présentant un lymphœdème du membre supérieur/inférieur (n = 184/122) ont été inclus. Pendant le TDI, la réduction médiane du volume du lymphœdème était de 31,0 % (41,7–19,9) suivie d’une réaugmentation de volume médian de 16,5 % (5,9–42,3) après six mois de traitement d’entretien. Un TDI antérieur était le seul facteur prédictif de cette réponse. Parmi les patients, 75,5 % rapportaient des lourdeurs de membre à l’inclusion contre 42,3 % à la fin du TDI et 62,6 % à la fin du suivi. Pendant le TDI, rougeurs de peau et marques de compression étaient fréquentes (10,5 et 8,2 % des patients), les lésions de frottement nécessitant l’arrêt du traitement étaient rares (1,4 %). Conclusions Le TDI diminue le volume du lymphœdème et les lourdeurs handicapantes de membre. Ce bénéfice s’atténue lors des six premiers mois du traitement d’entretien. L’amélioration du traitement d’entretien est indispensable à la persistance à long terme du bénéfice du TDI.
    Journal des Maladies Vasculaires 01/2014; · 0.24 Impact Factor
  • S Vignes
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    ABSTRACT: Two questions arise when considering the treatment of varicose veins and the development of lymphedema: can the treatment cause lymphedema? Can it worsen it? Primary lymphedema is rarely associated with varicose veins except in the lymphedema-distichiasis syndrome. Data available in the literature is essentially based on surgical treatment. Stripping on a normal limb may induce chronic lymphedema in almost 0.1% of cases. The risk of lymphedema after stripping in patients with previous pelvic surgery including lymph node excision and/or radiotherapy remains unknown. In patients with lower limb lymphedema wearing strong elastic compression stockings, stripping provides little clinical improvement and can worsen volume. The main objective is also to avoid venous complications. Lymphatic lesions related to stripping can be evaluated by lymphography or lymphoscintigraphy. New techniques for treating varicose veins (sclerotherapy, endovenous laser treatment, radiofrequency ablation) seem to induce fewer lymphatic complications. Further studies are required to confirm these results. Indications for treatment should be unquestionable and patients must be alerted to the potential risk of lymphedema or its worsening.
    Journal des Maladies Vasculaires 12/2013; · 0.24 Impact Factor
  • La Revue de Médecine Interne 09/2013; · 0.90 Impact Factor
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    ABSTRACT: Upper-limb lymphedema (ULL) occurs in 15%-20% of women after breast-cancer treatment. Its intensive therapy relies on complete (complex) decongestive physiotherapy (CDP), whose duration is not well-established. Determine optimal intensive-phase CDP duration for lymphedema-volume reduction and factors predicting its success, with the hope of halving it from 11 to 4days. All patients with ULL (08/2011-06/2012) after breast-cancer treatment referred to our Department of Lymphology in a rehabilitation facility for 11days of CDP were eligible. Lymphedema volume was calculated using the truncated-cone formula. Volume reduction considered clinically relevant after 4days was defined as ≥75% of the total reduction obtained after 11days. We included 129 women (mean age: 64 (range: 42-88) years). Mean (sd) lymphedema volume was 907 (558) ml at CDP onset, decreased to 712 (428) ml after 4days (vs. onset, P<.0001) and 606 (341) ml after 11days (vs. 4, P<.0001), corresponding to 33% total lymphedema-volume reduction. For all patients, 4days of CDP achieved 63% (sd 40%) of that total reduction, with ≥75% for 50 (39%) patients. Surgery-to-lymphedema-onset interval >2years was the only factor significantly associated with 4days achieving ≥75% of the total lymphedema-volume reduction. Intensive phase CDP for 11days obtained significantly more volume reduction of breast cancer-related ULL than 4.
    Gynecologic Oncology 07/2013; · 3.93 Impact Factor
  • La Revue de Médecine Interne 03/2013; · 0.90 Impact Factor
  • S Vignes
    European journal of vascular and endovascular surgery: the official journal of the European Society for Vascular Surgery 03/2013; · 2.92 Impact Factor
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    ABSTRACT: The quality standards of the French Society of vascular medicine for the ultrasonographic assessment of vascular malformations are based on the two following requirements Technical know-how: mastering the use of ultrasound devices and the method of examination. Medical know-how: ability to adapt the methods and scope of the examination to its clinical indication and purpose, and to rationally analyze and interpret its results. Aims of the quality standards To describe an optimal method of examination in relation to the clinical question and hypothesis. To achieve consistent practice, methods, glossary, and reporting. To provide good practice reference points, and promote a high-quality process. Items of the quality standards The three levels of examination; their clinical indications and goals. The reference standard examination (level 2), its variants according to clinical needs. The minimal content of the examination report; the letter to the referring physician (synthesis, conclusion and proposal for further investigation and/or therapeutic management). Commented glossary (anatomy, hemodynamics, semiology). Technical bases. Settings and use of ultrasound devices. Here, we discuss the methods of using ultrasonography for the assessment of peripheral vascular malformations and tumors.
    Journal des Maladies Vasculaires 02/2013; 38(1):29–42. · 0.24 Impact Factor
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    ABSTRACT: THE QUALITY STANDARDS OF THE FRENCH SOCIETY OF VASCULAR MEDICINE FOR THE ULTRASONOGRAPHIC ASSESSMENT OF VASCULAR MALFORMATIONS ARE BASED ON THE TWO FOLLOWING REQUIREMENTS: Technical know-how: mastering the use of ultrasound devices and the method of examination. Medical know-how: ability to adapt the methods and scope of the examination to its clinical indication and purpose, and to rationally analyze and interpret its results. AIMS OF THE QUALITY STANDARDS: To describe an optimal method of examination in relation to the clinical question and hypothesis. To achieve consistent practice, methods, glossary, and reporting. To provide good practice reference points, and promote a high-quality process. ITEMS OF THE QUALITY STANDARDS: The three levels of examination; their clinical indications and goals. The reference standard examination (level 2), its variants according to clinical needs. The minimal content of the examination report; the letter to the referring physician (synthesis, conclusion and proposal for further investigation and/or therapeutic management). Commented glossary (anatomy, hemodynamics, semiology). Technical bases. Settings and use of ultrasound devices. Here, we discuss the methods of using ultrasonography for the assessment of peripheral vascular malformations and tumors.
    Journal des Maladies Vasculaires 01/2013; · 0.24 Impact Factor
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    ABSTRACT: OBJECTIVE: This study aims to assess potential complications of autologous lymph-node transplantation (ALNT) to treat limb lymphoedema. DESIGN: Prospective, observational study. METHOD: All limb-lymphoedema patients, followed up in a single lymphology department, who decided to undergo ALNT (January 2004-June 2012) independently of our medical team, were included. RESULTS: Among the 26 patients (22 females, four males) included, 14 had secondary upper-limb lymphoedema after breast-cancer treatment and seven had secondary and five primary lower-limb lymphoedema. Median (interquartile range, IQR) ages at primary lower-limb lymphoedema and secondary lymphoedema onset were 18.5 (13-30) and 47.4 (35-58) years, respectively. Median body mass index (BMI) was 25.9 (22.9-29.3) kg m(-2). For all patients, median pre-surgery lymphoedema duration was 37 (24-90) months. Thirty-four ALNs were transplanted into the 26 patients, combined with liposuction in four lower-limb-lymphoedema patients. Ten (38%) patients developed 15 complications: six, chronic lymphoedema (four upper limb, two lower limb), defined as ≥2-cm difference versus the contralateral side, in the limb on the donor lymph-node-site territory, persisting for a median of 40 months post-ALNT; four, post-surgical lymphocoeles; one testicular hydrocoele requiring surgery; and four with persistent donor-site pain. Median (IQR) pre- and post-surgical lymphoedema volumes, calculated using the formula for a truncated cone, were, respectively, 1023 (633-1375) ml (median: 3 (1-6) months) and 1058 (666-1506) ml (median: 40 (14-72) months; P = 0.73). CONCLUSION: ALNT may engender severe, chronic complications, particularly persistent iatrogenic lymphoedema. Further investigations are required to evaluate and clearly determine its indications.
    European journal of vascular and endovascular surgery: the official journal of the European Society for Vascular Surgery 01/2013; · 2.92 Impact Factor
  • S. Vignes
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    ABSTRACT: Two questions arise when considering the treatment of varicose veins and the development of lymphedema: can the treatment cause lymphedema? Can it worsen it? Primary lymphedema is rarely associated with varicose veins except in the lymphedema-distichiasis syndrome. Data available in the literature is essentially based on surgical treatment. Stripping on a normal limb may induce chronic lymphedema in almost 0.1% of cases. The risk of lymphedema after stripping in patients with previous pelvic surgery including lymph node excision and/or radiotherapy remains unknown. In patients with lower limb lymphedema wearing strong elastic compression stockings, stripping provides little clinical improvement and can worsen volume. The main objective is also to avoid venous complications. Lymphatic lesions related to stripping can be evaluated by lymphography or lymphoscintigraphy. New techniques for treating varicose veins (sclerotherapy, endovenous laser treatment, radiofrequency ablation) seem to induce fewer lymphatic complications. Further studies are required to confirm these results. Indications for treatment should be unquestionable and patients must be alerted to the potential risk of lymphedema or its worsening.
    Journal des Maladies Vasculaires 01/2013; · 0.24 Impact Factor
  • S. Vignes
    Journal des Maladies Vasculaires 09/2012; 37(5):254. · 0.24 Impact Factor
  • Journal des Maladies Vasculaires 09/2012; 37(5):263. · 0.24 Impact Factor
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    ABSTRACT: Background:  Lymphedema is a general term applied to designate pathological regional accumulation of protein-rich fluid. It can be either primary or secondary, mainly after cancer treatment. Objective:  To analyze clinical and lymphoscintigraphic characteristics of primary upper-limb lymphedema. Method:  All patients with upper-limb lymphedema (January 2007-December 2011) recruited in a single Department of Lymphology were included. Results:  Sixty patients (33 females, 27 males) were enrolled. For the 54 noncongenital lymphedemas, mean age at onset was 38.5 (3-82) years. Lymphedema was unilateral in 51 (85%) patients. It always affected the hand, but less often the forearm (55%) or upper arm (23%). Eleven (18%) patients developed cellulitis after lymphedema onset. Twenty-one (35%) patients had associated lower-limb lymphedema. Forty-six patients (with 49 lymphedematous limbs) underwent lymphoscintigraphy: axillary lymph-node uptake was diminished in 18 (37%), absent in 24 (49%) and normal in 7 limbs (14%). Among the 43 patients with unilateral lymphedema and lymphoscintigraphy, 28 had epitrochlear node visualization, suggesting a re-routing through the deep lymphatic system, 15 only on the lymphedematous limb and 22 on the contralateral nonlymphedematous limb. Median follow-up was 103 months and 57/60 (95%) patients considered their lymphedema stable. Conclusion:  Primary upper-limb lymphedema appears later in life than lower-limb lymphedema without sex predominance. Infectious complications are rare and patients considered the lymphedema volume stable throughout life.
    British Journal of Dermatology 08/2012; · 3.76 Impact Factor
  • S. Vignes
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    ABSTRACT: Lipedema is a clinical entity frequently misdiagnosed or confound with primary lymphedema. Lipedema is a disorder of adipose tissue that occurs almost exclusively in obese women. It is characterized by bilateral enlargement from hip to ankle due to abnormal depositions of subcutaneous fat associated with often mild edema, usually sparing the feet. Disease onset is usually at or soon after puberty. Lipedema results in considerable frustration and distress resulting from the cosmetic appearance. Patients may complain of pain, tenderness, easy bruising of the affected areas with moderate to severe sensitivity to digital pressure or pinching. Imaging studies using computed tomography, magnetic resonance imaging, ultrasound, lymphoscintigraphy are not indicated, except if the diagnosis is atypic or doubtful. Long-term evolution may alter lymphatic system and lead to a lipo-lymphedema with specific complications such as cellulitis. Lipedema management is not codified and included weight loss (poorly improving leg appearance or discomfort), psychological counselling and compression therapy. Liposuction, especially using tumescent local anaesthesia, may reduce edema, spontaneous pain, sensitivity to pressure, bruising and improve appearance resulting in a important increase in quality of life.
    Journal des Maladies Vasculaires 07/2012; 37(4):213–218. · 0.24 Impact Factor
  • S Vignes
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    ABSTRACT: Lipedema is a clinical entity frequently misdiagnosed or confound with primary lymphedema. Lipedema is a disorder of adipose tissue that occurs almost exclusively in obese women. It is characterized by bilateral enlargement from hip to ankle due to abnormal depositions of subcutaneous fat associated with often mild edema, usually sparing the feet. Disease onset is usually at or soon after puberty. Lipedema results in considerable frustration and distress resulting from the cosmetic appearance. Patients may complain of pain, tenderness, easy bruising of the affected areas with moderate to severe sensitivity to digital pressure or pinching. Imaging studies using computed tomography, magnetic resonance imaging, ultrasound, lymphoscintigraphy are not indicated, except if the diagnosis is atypic or doubtful. Long-term evolution may alter lymphatic system and lead to a lipo-lymphedema with specific complications such as cellulitis. Lipedema management is not codified and included weight loss (poorly improving leg appearance or discomfort), psychological counselling and compression therapy. Liposuction, especially using tumescent local anaesthesia, may reduce edema, spontaneous pain, sensitivity to pressure, bruising and improve appearance resulting in a important increase in quality of life.
    Journal des Maladies Vasculaires 06/2012; 37(4):213-8. · 0.24 Impact Factor
  • S. Vignes
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    ABSTRACT: Lymphedema results from impaired lymphatic transport with increased limb volume. Cellulitis is the main complication, but psychological or functional discomfort may occur throughout the course of lymphedema. Lymphedema management is based on complete decongestive physiotherapy (multilayer low stretch bandage, manual lymph drainage, skin care, exercises). First phase of treatment leads to a reduction of lymphedema volume. The second phase stabilizes the volume and is based on elastic compression. Resection surgery is a useful tool in external genitalia lymphedema.
    La Revue de Médecine Interne. 05/2012; 33(5):268–272.
  • La Revue de Médecine Interne 04/2012; · 0.90 Impact Factor
  • Marie Blanchard, Maria Arrault, Stéphane Vignes
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    ABSTRACT: The study aims to determine the impact of delayed breast reconstruction on women with breast-cancer treatment-related lymphoedema after mastectomy. Twenty women with breast-cancer treatment-related arm lymphoedema prospectively requesting breast reconstruction were included between January 2002 and June 2009. Lymphoedema volume was calculated for each 5-cm segment using the formula for a truncated cone. Three patients underwent transverse rectus abdominis myocutaneous flap reconstruction, five received pedicled latissimus dorsi myocutaneous flaps associated with a breast implant and 12 a breast implant (silicone) alone. Median lymphoedema duration at the time of breast reconstruction was 21 (interquartile range (IQR): 17-34) months. Breast reconstruction was done a median of 30 (IQR: 23-56) months after mastectomy. The median lymphoedema volume at medians of 5 (244 ml, IQR: 159-435) and 22 months (235 ml, IQR: 146-361) of follow-up after reconstruction compared to that measured 6 months before breast reconstruction of 378 ml (IQR: 261-459) were significantly lower (p<0.02 for both). Specific lymphoedema treatment, unchanged during the study, included manual lymph drainage for all women, elastic sleeves for 19 and low-stretch bandages for 14. Delayed breast reconstruction is feasible for women who have developed lymphoedema after mastectomy for breast cancer. Further studies are needed to compare the different breast-reconstruction techniques and to determine their ideal timing (immediate or delayed).
    Journal of Plastic Reconstructive & Aesthetic Surgery 04/2012; 65(8):1060-3. · 1.44 Impact Factor

Publication Stats

473 Citations
121.85 Total Impact Points

Institutions

  • 2011–2013
    • Hôpital Européen Georges-Pompidou (Hôpitaux Universitaires Paris-Ouest)
      • Service de Médecine Interne
      Paris, Ile-de-France, France
  • 2010
    • Groupe Hospitalier Saint Vincent
      Strasburg, Alsace, France
  • 1996–2010
    • Hôpital La Pitié Salpêtrière (Groupe Hospitalier "La Pitié Salpêtrière - Charles Foix")
      • Service de Médecine Interne 1
      Lutetia Parisorum, Île-de-France, France
  • 2006
    • Institut Français de Chirurgie de la Main
      Lutetia Parisorum, Île-de-France, France