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

Abstract

Background: Lymphovenous anastomosis (LVA) is a microsurgical treatment for lymphedema of the lower extremity (LEL). This study systematically reviews the most recent data on outcomes of various LVA techniques for LEL in diverse patients. Methods: A comprehensive literature search was conducted in the Ovid MEDLINE, Ovid EMBASE, and Scopus databases to extract articles published through June 2021. Studies reporting data on objective postoperative improvement in lymphedema and/or subjective improvement in quality of life for patients with LEL were included. Extracted data comprised demographics, number of patients and lower limbs, duration of symptoms before LVA, surgical technique, duration of followup, and objective and subjective outcomes. Results: A total of 303 articles were identified and evaluated, of which 74 were ultimately deemed eligible for inclusion in this study, representing 6260 patients and 2554 lower limbs. The average patient age ranged from 22.6 to 76.14 years. The duration of lymphedema before LVA ranged from 12 months to 11.4 years. Objective rates of improvement in lymphedema ranged from 23.3% to 100%, with the greatest degree of improvement seen in patients with early-stage LEL. Conclusions: LVA is a safe and effective technique for the treatment of LEL of all stages. Several emerging techniques and variations may lead to improved patient outcomes.

Supermicrosurgical lymphovenous anastomosis

“…[27][28][29] Initially, it is noted that LVA is most suitable for patients with localized or early-stage lymphedema, where functional lymphatic vessels are still present. 10,[30][31][32] In cases of more advanced lymphedema or extensive fibrosis, alternative surgical options, such as lymph node transfer or vascularized lymph node flap, may be considered. But recently, Cha et al, 33 found that LVA can also effectively reduce the volume of the limb and improve subjective symptoms in patients with advanced stage lymphedema of the lower extremity.…”

“…2 for side-to-side anastomosis). 11,25,31,[92][93][94] The main determining factors for proper anastomotic configuration selection relies on the size and the comparative discrepancy between the lymphatic vessel and recipient vein. 95 To achieve a favorable antegrade flow of lymph into the vein, it is advisable to select a less sclerotic lymphatic duct with a larger diameter and a recipient vein with a smaller diameter for the anastomosis.…”

“…Subjective assessments often include symptom relief and/or validated quality of life measures, as well as the duration of compression therapy usage. 30,31 In terms of measurements around the limbs, the results vary widely, but most studies show significant improvements. Only a very small number of cases demonstrate no improvement post-surgery.…”

“…2 for side-to-side anastomosis). 11,25,31,92–94 The main determining factors for proper anastomotic configuration selection relies on the size and the comparative discrepancy between the lymphatic vessel and recipient vein. 95…”

Surgical management of lymphedema: Does a microsurgeon's bias exist?

“…Dear Editor, Microsurgical procedures for the treatment of lymphedema have become increasingly popularized over recent decades and an expanding body of evidence continues to demonstrate efficacy of these procedures. While many studies have reported a reduction in patient limb volume following microsurgical procedures, such reductions can be modest or may be limited to those with early-stage lymphedema (Verhey et al, 2022). Additionally, microsurgical procedures do not address the adipose component of the disease, which contributes to excess extremity volume in the majority of patients (Brorson et al, 2006).…”