Long‐term results after lymphatic‐venous anastomoses for the treatment of obstructive lymphedema

Abstract

Over the past 25 years, 665 patients with obstructive lymphedema have been treated with microsurgical lymphatic-venous anastomoses; of these, 446 patients were available for long-term follow-up study. Objective assessment was undertaken by water volumetry and lymphoscintigraphy. Lymphangioscintigraphy, lymphangiography (in patients with gravitational reflux pathology), and echo-Doppler were used preoperatively. Subjective improvement was noted in 578 patients (87%). Objectively, volume changes showed a significant improvement in 552 patients (83%), with an average reduction of 67% of the excess volume. Of those patients followed up, 379 patients (85%) have been able to discontinue the use of conservative measures, with an average follow-up of more than 7 years and average reduction in excess volume of 69%. There was a 87% reduction in the incidence of cellulitis after microsurgery. In those patients who improved, drainage resulted in increased softness of the limbs. Peripheral edema (hand and foot) diminished considerably in most patients. These long-term results indicate that lymphatic-venous anastomoses have a place in the treatment of obstructive lymphedema and should be the therapy of choice in patients who are not sufficiently responsive to nonsurgical treatment. Improved results can be expected with earlier operations because patients referred earlier usually have fewer lymphatic alterations.

Lymphaticovenular anastomoses for lymphedema treatment: 18 months postoperative outcomes

“…With this technique, the physiopathology is addressed and edema is resolved on a long-term basis. [12][13][14] On the basis of the promising results reported with LVA during the last decade, we started performing this operation in 2008. The following article presents our initial experience with this technique with thorough discussion of the results obtained.…”

Treatment of lymphedema with lymphaticovenular anastomoses

“…15 It finally develops into so-called elephantiasis, an excess fibrosis and hardening of the skin. Campisi et al 16 proposed a classification for the progress of lymphedema symptoms (stage I, initial and irregular edema; stage II, persistent edema; stage III, persistent and progressing edema with acute lymphangitis; stage IV, fibrolymphedema; and stage V, elephantiasis). Rare outcomes of lymphedema include lymphangiosarcoma (Stewart-Treves syndrome), the prognosis of which is extremely poor.…”

Preparing for and Coping with Breast Cancer-Related Lymphedema

“…For severe lymphedema, excisional operations and debulking procedures have been reported as effective methods to alleviate symptoms by removing fibrosclerotic connective tissue, excess adipose tissue, and excess skin. Various microsurgical techniques for lymphatic reconstruction have been attempted since the early 1960s, including the creation of anastomoses between lymphatic channels and adjacent veins, between lymph nodes and veins, and between distal and proximal lymphatics (Campisi et al, 2001;O'Brien et al, 1990). Lympho-lymphatic anastomosis and lymphatic grafting have been used as reconstructive techniques that are associated with improved patency over time (Brennan & Miller, 1998).…”