S. Vignes

Hôpital Européen Georges-Pompidou (Hôpitaux Universitaires Paris-Ouest), Lutetia Parisorum, Île-de-France, France

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Publications (144)122.29 Total impact

  • La Revue de Médecine Interne 07/2015; 36(9). DOI:10.1016/j.revmed.2015.06.013 · 1.07 Impact Factor
  • Neetish Gunnoo · Michel Ebelin · Maria Arrault · Stéphane Vignes ·
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    ABSTRACT: Carpal tunnel syndrome may occur in women with ipsilateral lymphedema after breast cancer treatment. Surgery on the lymphedematous arm is classically feared. Thirty-two consecutive women (mean age at cancer treatment 49 years, interquartile range (Q1;Q3) 43;56) with upper limb lymphedema after breast cancer treatment, followed in a single lymphology unit, and symptomatic carpal tunnel syndrome (electromyographically confirmed) requiring surgery were included. Lymphedema volume was calculated using the truncated cone formula, recorded before and after carpal tunnel syndrome surgery, and at each follow-up visit. Median time to lymphedema onset after cancer treatment was 19 (interquartile range (Q1;Q3) 5;73) months. Median lymphedema volume was 497 (Q1;Q3 355;793) mL before (median 4 months) and 582 (Q1;Q3 388;930) mL after carpal tunnel syndrome surgery (median 5 months) (P = 0.004). At the last follow-up post-carpal tunnel syndrome surgery (median 33 months), lymphedema volume was 447 (Q1;Q3 260;733) mL (non-significant, compared to pre-surgery volume). Regular lymphedema treatment included elastic sleeve (n = 31), low-stretch bandage (n = 20), and/or manual lymph drainage (n = 20), with no change before and after carpal tunnel syndrome surgery. All carpal tunnel syndrome clinical manifestations disappeared after surgery and none of the patients experienced local complications. Carpal tunnel syndrome may be treated surgically in women with ipsilateral upper limb lymphedema after breast cancer treatment. Although lymphedema volume increased transiently, it remained stable over long-term follow-up, with no local complications.
    Breast Cancer Research and Treatment 07/2015; 152(3). DOI:10.1007/s10549-015-3500-6 · 3.94 Impact Factor
  • S. Vignes ·
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    ABSTRACT: Published articles on lymphedema essentially concerns lymphedema after breast cancer treatment. Main risk factors include axillary lymph nodes excision, radiotherapy and obesity. Some other preventive advices are frequently given to women after breast cancer for daily life, physical activity, upper limb motion and invasive procedures such as blood pressure or venepuncture. All advices are consensual but empirical without solid data from the literature. Aim of this article is to analyze the data of published articles to modify the advices and recommendations given to the patients and finally improve lymphedema prevention and management. The new language should be clearly explained so that the modifications do not induce anxiety for the patients.
    Sang Thrombose Vaisseaux 05/2015; 27(3):143-150. DOI:10.1684/stv.2015.0882 · 0.01 Impact Factor
  • S. Vignes ·

    Journal des Maladies Vasculaires 03/2015; 40(2). DOI:10.1016/j.jmv.2014.12.074 · 0.24 Impact Factor
  • M. Arrault · S. Vignes ·

    Journal des Maladies Vasculaires 03/2015; 40(2). DOI:10.1016/j.jmv.2014.12.144 · 0.24 Impact Factor
  • S. Vignes · P. Trévidic ·

    Journal des Maladies Vasculaires 03/2015; 40(2). DOI:10.1016/j.jmv.2014.12.146 · 0.24 Impact Factor
  • M. Arrault · A. Auvity-Pontet · V. Gallier · S. Vignes ·

    Journal des Maladies Vasculaires 03/2015; 40(2):119. DOI:10.1016/j.jmv.2014.12.025 · 0.24 Impact Factor
  • Stéphane Vignes · Morgan Brunet · Marie Blanchard · Amar Smail · Maria Arrault ·
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    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; 12(3). DOI:10.1089/lrb.2014.0005 · 1.71 Impact Factor
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    ABSTRACT: Objective: Lymphedema treatment is based on Decongestive Lymphedema Therapy (DLT) with an intensive phase followed by a long-term maintenance phase. This study aimed to observe volume variation over the intensive phase and 6 months later. Methods: Prospective multicentre observational study of patients with unilateral lymphedema. The primary objective was to assess lymphedema volume variation between baseline, the end of intensive phase and 6 months later. Secondary objectives were to assess the frequency of heaviness limiting limb function and treatments safety predictors for volume reduction. Results: Three hundred and six patients (89.9% women; 59.9±14.3 years old) with upper/lower (n=184/122) limb lymphedema were included. At the end of the intensive phase, median excess lymphedema volume reduction was 31.0% (41.7-19.9) followed by a 16.5% (5.9-42.3) median increase over the 6-month maintenance period phase. Previous intensive treatment was the only significant predictor of this response. As compared to baseline, heaviness limiting limb use was much less frequently reported at the end of the reductive phase (75.5% versus 42.3% respectively), and was more frequent at the end of the maintenance phase (62.6%). The most frequent adverse events reported were skin redness and compression marks (18.4 and 15.7% of patients, respectively). Blisters requiring treatment stoppage were rare (1.4%). Conclusions: Intensive phase decreases lymphedema volume and heaviness limiting limb function. The benefit is partially abolished after the first 6 months of maintenance. There is a need to consider how to provide optimal patient care for the long-term control of lymphedema.
    Journal des Maladies Vasculaires 07/2014; 39(4). DOI:10.1016/j.jmv.2014.05.004 · 0.24 Impact Factor
  • S. Vignes ·
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    ABSTRACT: Lymphedema is a chronic disease whose treatment is symptomatic. 1. Treatment is based on complete decongestive physiotherapy associating intensive phase volumetric reduction and a maintenance phase. 2. Bandages recommended by the "HAS" are monotypes with short-stretch bandages (< 100%). 3. Elastic compression with high pressures (> 20 mmHg, use the overlay of elastic stockings) is essential for the stabilization of the volume in the long term. Its delivery must be made by orthesists or orthopedic pharmacist, trained in lymphedema management. 4. Integration into a therapeutic education program is essential to improve patient autonomy and observance.

  • La Revue de Médecine Interne 06/2014; 35(6):403–404. DOI:10.1016/j.revmed.2013.08.016 · 1.07 Impact Factor
  • S. Vignes · M. Brunet · M. Blanchard · M. Arrault-Chaya ·

    Journal des Maladies Vasculaires 03/2014; 39(2):124-125. DOI:10.1016/j.jmv.2013.12.034 · 0.24 Impact Factor
  • S. Vignes ·

    Journal des Maladies Vasculaires 03/2014; 39(2):135. DOI:10.1016/j.jmv.2013.12.016 · 0.24 Impact Factor
  • S. Vignes ·

    Journal des Maladies Vasculaires 03/2014; 39(2):108. DOI:10.1016/j.jmv.2013.12.134 · 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
  • S Vignes · M Blanchard · M Brunet · M Arrault · B Lebrun-Vignes ·

    La Revue de Médecine Interne 09/2013; · 1.07 Impact Factor
  • Stéphane Vignes · Marie Blanchard · Maria Arrault · Raphaël Porcher ·
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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; 131(1). DOI:10.1016/j.ygyno.2013.07.101 · 3.77 Impact Factor
  • S Vignes ·

    Annales de Dermatologie et de Vénéréologie 06/2013; 140(6-7):483-4. DOI:10.1016/j.annder.2013.04.098 · 0.92 Impact Factor

  • La Revue de Médecine Interne 03/2013; 34(5). DOI:10.1016/j.revmed.2013.02.024 · 1.07 Impact Factor
  • S Vignes ·

    European journal of vascular and endovascular surgery: the official journal of the European Society for Vascular Surgery 03/2013; 45(5). DOI:10.1016/j.ejvs.2013.01.035 · 2.49 Impact Factor

Publication Stats

572 Citations
122.29 Total Impact Points


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