A Novel Surgical Approach for Refractory Secondary Lymphedema of the Lower Extremity Accompanying Micro-Arteriovenous Fistula

Sakuma, Hisashi; Watanabe, Shiho; Kono, Hikaru

doi:10.1016/j.avsg.2019.10.098

Cited by 2 publications

(6 citation statements)

References 17 publications

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“…To the best of our knowledge, refractory lymphedema has never been reported following VLNT, while it has been described after LVA [43]. An attentive follow-up is necessary to identify the recurrence and treat those patients in time.…”

Section: Discussionmentioning

confidence: 95%

The Combination of Lymph Node Transfer and Excisional Procedures in Bilateral Lower Extremity Lymphedema: Clinical Outcomes and Quality of Life Assessment with Long-Term Follow-Up

Losco

Bolletta

Sire

et al. 2022

JCM

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Background: Bilateral lower extremity lymphedema is a rare and invalidating condition that poses a great challenge to the scientific community, and deeply affects the quality of life (QoL) of affected patients. A combined protocol consisting of lymph node transfer and a reductive method have never been reported for the treatment of this condition, except for small case series with brief follow-up periods. Methods: This retrospective study analyzed data of 29 patients, mean age 51 ± 17.1 years, who had been diagnosed with bilateral lower extremity lymphedema. Gastroepiploic vascularized lymph node transfer was performed in all the patients, and an excisional procedure was associated according to the clinical stage. Clinical history, circumferential limb measurements, complications, episodes of cellulitis, and responses to the Lymphedema Quality of Life Questionnaire were analyzed. Results: The mean follow-up was 38.4 ± 11.8 months. A significant reduction in the episodes of cellulitis per year was observed (p < 0.001). In our series, BMI and duration of symptoms were significantly related to the development of cellulitis during the postoperative period, p = 0.006 and p = 0.020, respectively. The LYMQoL questionnaire showed a significant quality of life improvement from 3.4 ± 0.9 to 6.2 ± 0.8 (p < 0.05). Conclusions: An integrated approach is essential for the treatment of bilateral lower extremity lymphedema: reductive and reconstructive methods are complementary to achieve a successful outcome. Timely treatment and BMI reduction are relevant in order to decrease the number of episodes of cellulitis. An attentive follow-up is necessary to identify recurrence and treat affected patients in time.

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Section: Discussionmentioning

confidence: 95%

The Combination of Lymph Node Transfer and Excisional Procedures in Bilateral Lower Extremity Lymphedema: Clinical Outcomes and Quality of Life Assessment with Long-Term Follow-Up

Losco

Bolletta

Sire

et al. 2022

JCM

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“…However, the perforators connecting with the micro-AVFs became incomplete due to the inflow of arterial blood, and ligation of incompetent perforators with pulsatile waveforms was suggested to be an indirect treatment for micro-AVFs [3]. Sakuma et al [5] also reported two cases in which ligation of an incompetent perforator with an arterialized waveform on ultrasonography improved secondary limb lymphedema. Uehara et al [11] described the treatment for left common iliac vein occlusion and ipsilateral internal iliac AVFs; the peripheral AVF was opened because of the rise in venous pressure due to iliac vein occlusion, and it was presumed that this was one of the causes of swelling and edema.…”

Section: Discussionmentioning

confidence: 99%

“…It has been reported that CTA was useful as a screening tool for micro-AVFs [3][4][5]. Since micro-AVFs have small calibers, it is difficult to accurately determine their presence via ultrasonography or arteriography.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…In such cases, there is no evidence of phlebostasis, such as deep venous thrombosis (DVT), and the effect of lymphaticovenular anastomosis (LVA) is not satisfactory. It is presumed that micro-AVFs are one of the reasons for this condition, but there are few reports on the association between lymphedema and micro-AVFs [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

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Micro-arteriovenous fistula in patients with lower limb lymphedema

et al. 2021

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Background A micro-arteriovenous fistula (AVF) is a minute, short shunt between an artery and a vein that does not pass through a capillary. We investigated the association between micro-AVFs and lymphedema using computed tomography angiography (CTA) and venous blood gas analysis.<br/>Methods In 95 patients with lower limb lymphedema, the presence or absence of early venous return (EVR) was compared between patients with primary and secondary lymphedema. Furthermore, we investigated the difference in the timing of edema onset in patients with secondary lymphedema with or without EVR using CTA. In 20 patients with lower limb lymphedema with confirmed early EVR in a unilateral lower limb, the partial pressure of oxygen (PO2) was compared between the lower limb with EVR and the contralateral lower limb.<br/>Results Secondary lymphedema with or without EVR occurred at an average of 36.0±59.3 months and 93.5±136.1 months, respectively; however, no significant difference was noted. PO2 was 57.6±11.7 mmHg and 44.1±16.4 mmHg in the EVR and non-EVR limbs, respectively, which was a significant difference (P=0.005).<br/>Conclusions EVR and venous blood gas analysis suggested the presence of micro-AVFs in patients with lower extremity edema. Further research is warranted to examine the cause of micro-AVFs, to advance technology to facilitate the confirmation of micro-AVFs by angiography, and to improve lymphedema by ligation of micro-AVFs.

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A Novel Surgical Approach for Refractory Secondary Lymphedema of the Lower Extremity Accompanying Micro-Arteriovenous Fistula

Cited by 2 publications

References 17 publications

The Combination of Lymph Node Transfer and Excisional Procedures in Bilateral Lower Extremity Lymphedema: Clinical Outcomes and Quality of Life Assessment with Long-Term Follow-Up

The Combination of Lymph Node Transfer and Excisional Procedures in Bilateral Lower Extremity Lymphedema: Clinical Outcomes and Quality of Life Assessment with Long-Term Follow-Up

Micro-arteriovenous fistula in patients with lower limb lymphedema

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