Lymphatic Center Programs and Services

The Lymphatic Medicine Clinic has evaluated over 1000 new patients for lymphatic disorders since 2016. Brett Carroll, MD, cardiologist and Director of Vascular Medicine, and Betsy Rose, NP, lymphatic medicine nurse practitioner, thoroughly assess each patient to understand the cause of their symptoms. The focus of the clinic is to assure an accurate diagnosis and optimize management in close coordination with lymphatic therapy.

The Lymphatic Surgery Clinic evaluates patients for surgical interventions such as lymph node transplantation, lymphovenous bypass, and debulking procedures to treat lymphatic disorders. Moreover, the clinic evaluates patients for immediate lymphatic reconstruction to reduce the risk of developing lymphedema in high-risk patients, often cancer patients undergoing extensive lymph node removal.

Surgery to Prevent Lymphedema

Surgery to prevent lymphedema is known as lymphovenous bypass, and our surgeons reroute damaged lymph channels so that lymphatic fluid is able to drain properly.

Since we operate in conjunction with a cancer surgeon, you go to the OR only once. As the surgeon prepares to remove lymph nodes, we will inject a fluorescent dye into the limb closest to the site of surgery.

Using a specially designed microscope made for lymphatic surgery with a filter that can visualize the glowing dye, we locate the tiny lymph vessels and observes how fluid is flowing through them. If we detect any leaking vessels, our surgeons isolate the damaged channels and reroute them into a vein nearby. After the lymphatic flow is restored, the cancer surgeon completes the original operation.

This surgery prevents lymphedema in many patients. Unfortunately, some patients may still develop lymphedema. For that reason, we closely monitor your recovery. If lymphedema develops, we want to intervene as early on as possible, when physical therapy and other treatments are most likely to be effective.

Surgery to Treat Lymphedema

If you already have lymphedema, the first steps in treatment are:

• A type of physical therapy known as manual lymphatic drainage
• Compression garments
• Exercise

If these methods do not help, vascularized lymph node transfer may provide another option.

During this procedure, our team removes healthy lymph nodes and vessels from another area of your body and implant them near the arm or leg affected by lymphedema. This helps to help improve the flow of the lymphatic fluid in the affected area as the body heals with the goals of improving swelling and mobility.

It usually takes about a year for the transplanted lymph nodes and vessels to become fully functional. We will monitor your recovery closely.

The Lymphatic Therapy Clinic offers world-class care in the conservative management and diagnosis of lymphedema. The clinic is led by Kathy Shillue, Director of Outpatient Rehabilitation Services, who has dedicated the last 20 years of her career to the management of lymphedema. The inpatient team is led by Tegan Guilfoyle.

Surgical Follow-up and Physical Therapy

At BIDMC, patients who are at increased risk of lymphedema are evaluated before they undergo cancer treatment. For example, a measurement before surgery is important to establish your “normal” level of lymph fluid so that any increase after cancer treatment can be identified early.

As part of the pre-surgical process, your doctor will send an order for physical therapy through the online medical record system. Your appointment will be coordinated with your other pre-operative appointments.

At the first meeting, a physical therapist takes measurements of your fluid level, height, weight, limb size and limb movement. BIDMC has advanced technology that can detect even small increases in lymph fluid — even before swelling is visible.

After cancer treatment, follow-up visits at our Lymphedema Clinic are scheduled in three- to six-month intervals, depending on your risk for lymphedema. This ensures that we can detect any increase in lymph fluid levels before symptoms develop. The earlier lymphedema is detected, the more effective are additional interventions, such as compression or massage.

If you already have lymphedema, we will take baseline measurements of your arm or leg during your first visit at the Lymphedema Clinic. Then we will develop a personalized treatment plan and schedule follow-up visits as needed to monitor your recovery.

The Lymphatic Imaging Group offers the full spectrum of diagnostic imaging including ultrasound, MRI, MR-Lymphangiography, Lymphoscintigraphy, SPECT-CT imaging, and Lymphangiography. The group also performs interventional procedures such as vascular and lymphatic stenting, embolization, and angioplasty. Physicians utilize sclerotherapy to treat vascular malformations and other vascular anomalies. Members of Lymphatic Imaging are actively engaged in lymphatic imaging research with funding support from the Radiologic Society of North America and NIH. The group is led by Leo Tsai, MD, Director of MRI at BIDMC.