Lymphaticovenous anastomosis for advanced‐stage lower limb lymphedema

Abstract

Background Early‐stage lymphedema patients are said to be candidates for lymphaticovenous anastomosis (LVA). The progressions in the preoperative examinations have made it possible to find the suitable lymphatic vessels even in advanced‐stage lymphedema. The aim of this study was to elucidate the surgical effect of LVA in cases of advanced‐stage lymphedema. Methods We evaluated 42 limbs of 34 patients with lymphoscintigraphic type 4 or 5. A mean disease duration was 7.5 ± 6.5 years. We performed multi‐lymphosome indocyanine green (ICG) lymphography preoperatively to detect the saphenous lymphatics, the lateral calf lymphatics, and the lateral thigh lymphatics. We also performed ultrasound to detect the subcutaneous veins and the dilated lymphatic vessels. The pre‐ and postoperative evaluation was made by the sum of circumference measurements at 6 points per limb. Results The mean number of anastomosis per limb was 2.8 (range, 1–5). Of the 41 limbs for which we performed ICG lymphography, we found the saphenous lymphatics in 29 limbs (70.7%), lateral calf lymphatics in 28 limbs (68.3%), and lateral thigh lymphatics in 21 limbs (51.2%). We found at least 1 linear pattern in ICG lymphography for 39 limbs (95.1%). The mean pre‐ and postoperative circumference (sum of 6 points) were 221.7 ± 4.9 cm and 215.9 ± 4.9 cm, which was significantly reduced (p < .01). Conclusions LVA was effective for advanced‐stage lymphedema patients. An adequate preoperative examination with plural imaging methods seems helpful for achieving a successful surgical result.

Lower Limb Lymphedema Patients Can Still Benefit from Supermicrosurgical Lymphaticovenous Anastomosis (LVA) after Vascularized Lymph Node Flap Transfer (VLNT) as Delayed Lymphatic Reconstruction—A Retrospective Cohort Study

“…First, they were reluctant to receive further surgery, and second, they were unaware that their lymphedema could be improved further with LVA. However, supporting articles are currently being published regarding the use of LVA on severe lymphedema [ 6 , 7 , 8 ]. Formerly, VLNT was the only treatment option recommended for severe lymphedema [ 5 ].…”

“…Based on previous consensus, VLNT was recommended for moderate-to-severe cases, whereas LVA is reserved exclusively for mild lymphedema [ 2 , 5 ]. However, emerging evidence supports the use of LVA on severe lymphedema patients [ 6 , 7 , 8 ].…”

Multipoint injection indocyanine green lymphography can reduce lymphaticovenular anastomosis surgical time and improve the surgical results for lymphedema

“…ICG lymphography can show lymph vessels immediately after injection of ICG. When images of lymph vessels are unclear, the ICG injection site should be massaged manually [13] .…”

Optimizing Treatment of Breast Cancer Related Lymphedema Using Combined DIEP Flap and Lymphedema Surgery

“…Further, the ultrasound allows for visualization of lymphatics and venules that cannot be identified using ICG allowing the ability to perform an LVB even in more advanced stage lymphedema. 19 20 21…”