Supermicrosurgical deep lymphatic vessel‐to‐venous anastomosis for a breast cancer‐related arm lymphedema with severe sclerosis of superficial lymphatic vessels

Abstract

Lymphatic supermicrosurgery or supermicrosurgical lymphaticovenular anastomosis (LVA) is becoming popular for the treatment of compression-refractory upper extremity lymphedema (UEL) with its effectiveness and minimally invasiveness. In conventional LVA, superficial lymphatic vessels are used for anastomosis, but its treatment efficacy would be minimum when superficial lymphatic vessels are severely sclerotic. Theoretically, deep lymphatic vessels can be used for LVA, but no clinical case has been reported regarding deep lymphatic vessel-to-venous anastomosis (D-LVA). We report a breast cancer-related UEL case treated with D-LVA, in which a less-sclerotic deep lymphatic vessel was useful for anastomosis but superficial lymphatic vessels were not due to severe sclerosis. A 62-year-old female suffered from an 18-year history of compression-refractory right UEL after right breast cancer treatments, and underwent LVA under local infiltration anesthesia. Because superficial lymphatic vessels found in surgical fields were all severely sclerotic, a deep lymphatic vessel was dissected at the cubital fossa. A 0.50-mm deep lymphatic vessel running along the brachial artery was supermicrosurgically anastomosed to a nearby 0.40-mm vein. At postoperative 12 months, her right UEL index decreased from 134 to 118, and she could reduce compression frequency from every day to 1-2 days per week to maintain the reduced lymphedematous volume. D-LVA may be a useful option for the treatment of compression-refractory UEL, when superficial lymphatic vessels are severely sclerotic. © 2015 Wiley Periodicals, Inc. Microsurgery 37:156-159, 2017.

Constitutively Enhanced Lymphatic Pumping in the Upper Limbs of Women Who Later Develop Breast Cancer-Related Lymphedema

“…Severe sclerosis was observed in superficial lymphatics in the upper limb of a patient with refractory BCRL of 18 years' duration. 43 Inflammatory triggers for the above might be aggravated by the association between obesity and an abnormal inflammatory response, perhaps involving macrophage migration.…”

Lymphovenous Anastomosis Bypass Surgery

“…In patients with this scenario, an LVA can still be effective if performed properly despite the fibrosis and sclerosis of the superficial lymphatic channels. 45 Other institutions that perform lymphedema surgery have also demonstrated similar outcomes; however, certainly, the number of institutions with high-volume and long-term outcomes are limited. Studies have demonstrated a certain percentage of thrombosis or sclerosis of the bypasses following an LVA, which can lead to recurrent lymphedema and swelling over time.…”

Vein wrapping technique for side‐to‐end anastomosis in lymphatic venous anastomosis

“…Lymphatic venous anastomosis (LVA) using a microsurgical approach has become increasingly popular for patients needing lymphatic surgery. Although most advanced staged patients often have highly stenotic and fibrotic lymphatic vessels (Yamamoto, Yamamoto, Hayashi, & Koshima, 2017), some retain strong flow and can still achieve effective LVA. Small-caliber veins are usually dissected to minimize any size discrepancy.…”