Combining superficial and deep lymphovenous anastomosis for lymphedema treatment: Preliminary results

Abstract

Background: Superficial lymphovenous anastomosis (LVA) is a widely accepted procedure for treatment of mild-to-moderate lymphedema throughout the body.Anyway, not always are the superficial lymphatic vessels suitable for the anastomosis nor do they provide a sufficient drainage to significantly improve the condition. The continuous progress of supermicrosurgical technique over the last few years and the recent anatomical researches about the deep lymphatic network opened new perspectives for those lymphedema cases refractory to conventional procedures.Resorting to deep lymphatic vessels offer an additional opportunity to further improve the result obtained by means of superficial LVA. The aim of this report is to describe our experience treating lymphedema with superficial and deep lymphatic vessels LVA.Patients and Methods: Eight female patients presenting secondary (seven cases) and primary (one case) lymphedema, previously treated by means of multiple superficial LVAs, were considered eligible for deep lymphatics surgery to further improve their results. The affected area was the upper limb in one case and the lower limbs in seven cases. All the patients were evaluated preoperatively and postoperatively resorting to Campisi criteria. Four cases were initially classified as stage III, two stage IV, and two stage II. Five patients received deep LVA in the groin, two patients in the ankle along the posterior tibial artery and one in the wrist along the radial artery.Results: In all eight patients both subjective and objective improvements of the condition were reported with decrease of swelling and relief from heaviness sensation.The postoperative course was always uneventful and at the 9 months follow up none of the patients presented recurrence of the disease, even with the complete removal of compressive therapy.Conclusions: Deep lymphatic vessels LVA might represent a valid alternative to the superficial ones to treat lymphedema when previous results are not satisfactory nor when no superficial lymphatic vessels are available for anastomosis.

Surgical Treatment for Primary Lymphedema: A Systematic Review of the Literature

“…1 . 5 21 22 26 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 …”

Outcomes of Lymphovenous Anastomosis for Lower Extremity Lymphedema: A Systematic Review

“…Studies were conducted retrospectively, other than 14 performed prospectively. 22,[28][29][30][31]42,47,52,[54][55][56]59,66,84 No randomized control trials (RCTs) were identified. Mean duration of lymphedema symptoms before treatment ranged from 12 months 29,65 to 11.4 years.…”

“…27,66,68,71,80 The remaining 41 studies included patients with either primary or secondary lymphedema. [16][17][18][19][20]22,24,[29][30][31][32][33][34][35][36]41,[43][44][45][46][50][51][52][54][55][56][57][58][59]61,67,72,75,76,78,81,82,84,85,88,89 Baseline and post-surgical lymphedema objective assessment were performed in various ways, including circumferential limb measurements in 34 studies, magnetic resonance volumetry in three studies, body weight in one study, body composition analysis (used to determine changes in extracellular fluid (ECF) volume) in one study, perometer limb volumetry in two studies, bioelectrical impedance in one study, computed tomography measurement of subcutaneous fat thickness in one study, lymphoscintigraphy in one study, ICG lymphography in three...…”

“…34,45 Regarding surgical technique, Aljindan et al 36 compared side-to-end to end-to-end LVA, noting improved results in the side-to-end group. Scaglioni et al 22 compared prior LVA of superficial lymphatics with LVA of deep lymphatics, noting significantly better outcomes in the latter group. Other surgical techniques investigated included lymph node to vein anastomosis, 21 a line production technique to shorten operative time, 47 "pi-shaped" anastomosis, 66 and side-to-end LVA using temporary lymphatic expansion.…”

Lymphaticovenous Anastomosis for Treating Secondary Lower Limb Lymphedema in Older Patients—A Retrospective Cohort Study

“…Supermicrosurgical lymphaticovenous anastomosis (LVA), which is a minimally invasive bypass surgery that improves lymphedema by channeling the stagnant lymphatic fluid from the lymphatic vessels of the affected limbs into the recipient veins [ 24 , 29 , 30 , 31 , 32 , 33 ], has been accepted as a standard surgical procedure for LLL. Emerging evidence supports the therapeutic benefits of LVA, not only in patients with mild lymphedema, but also in those with more severe conditions [ 31 , 34 , 35 , 36 , 37 ]. However, despite the increasing prevalence of LLL and the potential complications of untreated LLL in older individuals, the effectiveness of LVA for treating secondary LLL in this patient population remains a clinical challenge when considering the unfavorable age- and lymphedema-related lymphatic changes.…”