S. Vignes

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

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Publications (163)

  • S. Vignes
    [Show abstract] [Hide abstract] ABSTRACT: Les lymphœdèmes sont la conséquence d’une stase lymphatique, puis d’une augmentation de volume du membre atteint. Ils sont classés en lymphœdèmes primaires et lymphœdèmes secondaires. Les lymphœdèmes secondaires du membre supérieur, après traitement d’un cancer du sein, sont les plus fréquents en France. Les lymphœdèmes primaires sont le plus souvent sporadiques, parfois familiaux ou peuvent faire partie de syndromes malformatifs ou génétiques plus complexes. Le diagnostic de lymphœdème est clinique mais dans les formes primaires, la lymphoscintigraphie permet d’évaluer précisément la fonction lymphatique. L’érysipèle est la principale complication des lymphœdèmes en dehors du retentissement fonctionnel et psychologique, parfois important. Le principal diagnostic différentiel des lymphœdèmes des membres inférieurs est le lipœdème défini par une répartition anormale des graisses allant des hanches jusqu’aux chevilles. Le traitement repose sur la physiothérapie décongestive complète (bandages peu élastiques avec des bandes à allongement court, drainages lymphatiques manuels, soins de peau, exercices) dont la première phase, intensive, permet de diminuer le volume et la seconde de le stabiliser par le port de compression élastique. L’éducation thérapeutique, incluant l’apprentissage des autobandages, est indispensable pour favoriser l’autonomie du patient.
    Article · Aug 2016
  • S. Vignes
    Article · Jun 2016 · Journal des Maladies Vasculaires
  • F. Vidal · M. Arrault · S. Vignes
    [Show abstract] [Hide abstract] ABSTRACT: Lymphoedema is a general term designating pathologic conditions with excessive, regional accumulation of protein-rich fluid, leading to slow limb enlargement with adipose-tissue deposition and excess collagen production (fibrosis).(1) Lymphoedema is classically divided into two forms: primary and secondary, essentially after cancer treatment in adult. The International Society for the Study of Vascular Anomalies (ISSVA) classifies primary lymphoedema as a simple vascular malformation in a subtype of lymphatic malformation due to a primary abnormality of the lymphatic system.(2) Lymphoedema in children is rare, with an estimated prevalence of 1·15 cases/100,000 persons <20 years old in a 1985 study.(3) This article is protected by copyright. All rights reserved.
    Article · Mar 2016 · British Journal of Dermatology
  • S. Vignes · M. Arrault
    Article · Dec 2015 · La Revue de Médecine Interne
  • Article · Jul 2015 · La Revue de Médecine Interne
  • Neetish Gunnoo · Michel Ebelin · Maria Arrault · Stéphane Vignes
    [Show abstract] [Hide abstract] 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.
    Article · Jul 2015 · Breast Cancer Research and Treatment
  • S. Vignes
    [Show abstract] [Hide abstract] 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.
    Article · May 2015 · Sang Thrombose Vaisseaux
  • S. Vignes
    Article · Mar 2015 · Journal des Maladies Vasculaires
  • M. Arrault · S. Vignes
    Article · Mar 2015 · Journal des Maladies Vasculaires
  • S. Vignes · P. Trévidic
    Article · Mar 2015 · Journal des Maladies Vasculaires
  • Article · Mar 2015 · Journal des Maladies Vasculaires
  • Stéphane Vignes
    [Show abstract] [Hide abstract] ABSTRACT: Complex decongestive therapy (CPT) comprises two successive stages: An intensive phase to reduce lymphedema volume and a maintenance phase to stabilize lymphedema volume. Compression (low-stretch bandage, elastic garment) is the cornerstone of lymphedema treatment. Exercises under the supervision of a trained therapist, nail and skin care, manual lymph drainage are also included in CPT. Patient-education programs, including self-management, aim to improve patient autonomy. Specific consultation with a dietician or nutritionist is required for overweight and obese patients. Therapeutic goals should be defined with the patient and the different therapists implicated in the patient’s management.
    Article · Jan 2015
  • Stéphane Vignes · Morgan Brunet · Marie Blanchard · [...] · Maria Arrault
    [Show abstract] [Hide 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.
    Article · Aug 2014 · Lymphatic Research and Biology
  • [Show abstract] [Hide abstract] 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.
    Article · Jul 2014 · Journal des Maladies Vasculaires
  • S. Vignes
    [Show abstract] [Hide abstract] 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.
    Article · Jun 2014
  • S. Vignes · M. Blanchard · M. Brunet · [...] · B. Lebrun-Vignes
    Article · Jun 2014 · La Revue de Médecine Interne
  • Article · Mar 2014 · Journal des Maladies Vasculaires
  • S. Vignes
    Article · Mar 2014 · Journal des Maladies Vasculaires
  • S. Vignes
    Article · Mar 2014 · Journal des Maladies Vasculaires
  • S Vignes
    [Show abstract] [Hide abstract] 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. Copyright © 2013 Elsevier Masson SAS. All rights reserved.
    Article · Dec 2013 · Journal des Maladies Vasculaires

Publication Stats

815 Citations


  • 2011-2012
    • Hôpital Européen Georges-Pompidou (Hôpitaux Universitaires Paris-Ouest)
      • Service de Médecine Interne
      Lutetia Parisorum, Île-de-France, France
  • 2010
    • Hôpital La Pitié Salpêtrière (Groupe Hospitalier "La Pitié Salpêtrière - Charles Foix")
      • Service de Médecine Interne 1
      Lutetia Parisorum, Île-de-France, France
    • Groupe Hospitalier Saint Vincent
      Strasburg, Alsace, France
  • 2009
    • Assistance Publique – Hôpitaux de Paris
      Lutetia Parisorum, Île-de-France, France