Diagnosis and treatment of mixed lymphaticovenous obstruction - an underrecognized cause of lymphatic dysfunction

• Understand the clinical context and significance of mixed lymphaticovenous obstruction in interventional radiology.


• Consider approaches to imaging, such as lymphangiography and venography, for diagnosis of this clinical problem.


• Explore approaches to venous intervention in this population, including angioplasty and stent placement, highlighting select cases.


• Evaluate indicators of technical and clinical success in treated mixed lymphaticovenous obstruction.

Mixed lymphaticovenous obstruction is an underrecognized condition consisting of a combination of venous stenosis/occlusion and lymphatic dysfunction. It may present as secondary lymphedema or persistent symptoms of lymphatic obstruction despite lymphatic intervention. Optimal treatment for this condition has not been fully explored. A small number of cases have demonstrated the utility of imaging and venous intervention in improving lymphatic obstruction and associated symptoms. The purpose of this exhibit is to educate clinicians regarding the diagnosis and management of mixed lymphaticovenous obstruction.

Clinical Findings/Procedure Details:

The etiology of mixed lymphaticovenous obstruction can be broad. Often, patients present with lymphedema and history of surgery, trauma, malignancy with subsequent treatment, or some combination thereof. For patients with physical exam suggestive of lymphatic dysfunction, lymphangiography is often utilized to determine diagnosis and can evaluate for lymphatic function. If lymphangiography demonstrates lymphatic collaterals without lymphatic obstruction or lymphaticovenous communications, there is increased concern for potential venous involvement. In such cases, interventionalists should perform venography to assess for venous stenosis as a cause for increased lymphovenous pressure and lymphatic dysfunction. For confirmed cases of mixed lymphaticovenous obstruction, venous angioplasty or stent placement may be performed. Technical success is defined as the resolution of venous stenosis after intervention while clinical success is measured by the resolution of edema and improvement in symptoms at subsequent follow-up. Select cases will be highlighted to demonstrate how this approach applies to the affected patient population.

Conclusion and/or Teaching Points:

Venous intervention can resolve symptoms of mixed lymphaticovenous obstruction in select patients, demonstrating that treating the venous aspect of lymphaticovenous obstruction may ameliorate lymphatic dysfunction. IR plays an important role in furthering the diagnosis and management of this condition.