Systematic review of lymphovenous anastomosis (LVA) for the treatment of lymphedema

Scaglioni, Mario F.; Fontein, D.B.Y.; Arvanitakis, Michael; Giovanoli, Pietro

doi:10.1002/micr.30246

Cited by 178 publications

(136 citation statements)

References 39 publications

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“…Moreover, some relevant systematic reviews are in line with our conclusions despite the fact that these systematic reviews had a different aim (Sharkey et al, ) or included also retrospective studies (Scaglioni et al, ). Due to the methodological shortcomings of the available evidence, no conclusions can be made about the effectiveness of the procedure.…”

Section: Discussionsupporting

confidence: 88%

Efficacy and safety assessment of lymphovenous anastomosis in patients with primary and secondary lymphoedema: A systematic review of prospective evidence

Rosian

Stanak

2019

Microsurgery

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IntroductionLymphoedema is a chronic, debilitating condition caused by an affected lymphatic system. Supermicrosurgical techniques like lymphovenous anastomosis (LVA) have gained popularity because of its minimal invasiveness, better aesthetic outcome, and lower costs in comparison to physical medicine. This systematic review aims to evaluate the clinical effectiveness and safety of LVA in comparison to conservative or other surgical treatments for primary or secondary lymphoedema patients.Materials and MethodsA systematic literature search was performed in four databases in December 2017. We applied a methodological framework based on the HTA Core Model®. According to the grading of recommendations, assessment, development, and evaluation (GRADE) scheme, we synthesized the data on each selected outcome category. The studies were systematically assessed for risk of bias (RoB) using the Risk of Bias Assessment tool for Non‐randomized controlled studies (RoBANS) and the Institute of Health Economics (IHE) Risk of Bias checklist for case series.ResultsA total of 629 citations were identified and five studies were assessed eligible for final inclusion (one non‐randomized controlled trial and four prospective single‐arm studies). Across the studies, 217 patients were enrolled. All studies showed a moderate to high RoB. The strength of evidence for the effectiveness and safety of LVA is “very low.” Due to the methodological shortcomings of the available evidence, no conclusions can be made about the effectiveness of the procedure.ConclusionLVA might be a safe technique for patients with primary and secondary lymphoedema—particularly because no serious complications were reported. Furthermore, LVA may have a role in the prevention of lymphoedema.

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Section: Discussionsupporting

confidence: 88%

Efficacy and safety assessment of lymphovenous anastomosis in patients with primary and secondary lymphoedema: A systematic review of prospective evidence

Rosian

Stanak

2019

Microsurgery

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“…For patients with advanced stage lymphedema, conservative therapy is often ineffective and surgical management is required . Surgical approaches can be divided into physiological and excisional .…”

Section: Discussionmentioning

confidence: 99%

Combined double vascularized lymph node transfers and modified radical reduction with preservation of perforators for advanced stages of lymphedema

Ciudad

Manrique

Adabi

et al. 2019

Journal of Surgical Oncology

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Background Treatment of advanced lymphedema requires not only restoration of physiological lymph drainage, but also excision of fibrotic tissue and excess skin. The aim of this study is to show how the combination of double vascularized lymph node transfers (VLNTs) and a modified radical reduction with preservation of perforators (RRPP) can accomplish both of these treatment goals. Methods Between 2010 and 2016, 16 patients (15 female and one male) with extremity lymphedema underwent a combined double gastroepiploic VLNTs and modified RRPP. Demographics, outcomes including circumference reduction rates, preoperative and postoperative lymphoscintigraphy, complications, and responses to the Lymphedema Quality of Life (LYMQOL) questionnaire were analyzed. Results All flaps survived. The mean follow‐up period was 14.2 months (range, 12‐19). The mean circumference reduction rate was 74.5% ± 6.9% for the upper limb and 68.0% ± 4.2% for the lower limb. There were no major complications. Minor complications, including numbness and hyperesthesia, were treated conservatively. LYMQOL showed a 2.7‐fold quality‐of‐life improvement (P < 0.01). Postoperative lymphoscintigraphy showed improved lymphatic drainage in all cases. Conclusion Combined double VLNTs and modified RRPP safely and effectively improves lymphatic drainage, reduces fibrotic tissue and excess skin, decreases episodes of infections, and improves patients’ quality of life in the advanced stages of lymphedema.

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“…While manual lymphdrainage is usually applied in the postoperative phase, compression therapy is more difficult given the anatomy. Whereas lymphovenous anastomosis (LVA) has proved an effective treatment option for extremity lymphedema (Scaglioni, Fontein, Arvanitakis, & Giovanoli, ), we have described its efficacy in the treatment of breast lymphedema in women (Giacalone & Yamamoto, ; Yamamoto, Yamamoto, & Giacalone, ).…”

Section: Introductionmentioning

confidence: 99%

Successful treatment of breast cancer‐related breast lymphedema by lymphovenous anastomosis in a male patient

et al. 2019

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Men, as well as women may develop breast lymphedema following breast cancer treatment. Microsurgically performed lymphovenous anastomosis (LVA), an effective treatment for lymphedema of the extremities, has also been successfully applied to breast lymphedema. Here we report the first case of breast lymphedema secondary to male breast cancer, treated with supermicrosurgical LVA. A 48‐year‐old man presented with breast lymphedema following mastectomy, axillary lymph node dissection, and adjuvant radiotherapy. After the oncological treatments, the patient reported a sensation of tension, pain, and swelling of the left breast. The diagnosis of breast lymphedema was confirmed by lymphoscintigraphy. Since conservative treatment with manual lymphdrainage was ineffective, we performed LVAs at the left breast region. In total, two lymph vessels were anastomosed to two nearby veins. Immediately following this intervention, the left breast and lateral thorax region decreased in size and the sensation of tension disappeared. One year postoperative there was no recurrence of the swelling and the patient was very satisfied with the result. Although more reports are needed to confirm its efficacy, supermicrosurgical LVA appears to be a valuable treatment option for breast lymphedema in both women and men.

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Systematic review of lymphovenous anastomosis (LVA) for the treatment of lymphedema

Abstract: Although the studies included in this review showed great heterogeneity, LVA surgery revealed both objective and subjective improvements in most patients.

Cited by 178 publications

References 39 publications

Efficacy and safety assessment of lymphovenous anastomosis in patients with primary and secondary lymphoedema: A systematic review of prospective evidence

Efficacy and safety assessment of lymphovenous anastomosis in patients with primary and secondary lymphoedema: A systematic review of prospective evidence

Combined double vascularized lymph node transfers and modified radical reduction with preservation of perforators for advanced stages of lymphedema

Successful treatment of breast cancer‐related breast lymphedema by lymphovenous anastomosis in a male patient

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