Postoperative Changes in Lymphoscintigraphic Findings After Lymphaticovenous Anastomosis

The surgical result of lymphaticovenous anastomosis (LVA) is usually evaluated using the volume or circumference measurement. The purpose of this study was to elucidate the changes in lymphoscintigraphic findings after LVA.

We conducted a retrospective study on patients who underwent LVA and preoperative and postoperative lymphoscintigraphy from August 2014 to September 2017. In lymphoscintigraphy, albumin labeled with Tc (222 MBq) was injected to the first web space of the foot or the second web of the hands. We evaluated the findings and diagnosed them as "improved" if the extent of dermal backflow was decreased. The clinical symptom was evaluated using circumference measurement and subjective symptoms.

A total of 56 patients (107 limbs) were included. The mean age was 59.1 years. The mean period between LVA and postoperative lymphoscintigraphy was 437.0 days. The difference between preoperative and postoperative lymphoscintigraphic types in Maegawa classification was not found to be statistically significant on the χ test (P = 0.36). The lymphoscintigraphic findings were improved in 26 limbs (24.3%), did not change in 43 limbs (40.2%), and were aggravated in 38 limbs (35.5%). Among the 22 limbs whose lymphoscintigram improved postoperatively, 9 limbs (40.9%) improved in clinical symptoms.

The changes in clinical symptoms and the postoperative lymphoscintigraphic changes did not always correspond. However, there was a tendency for the percentage of lymphoscintigraphic aggravation to be higher in the group with clinical aggravation.