Lymphaticovenous anastomosis for advanced-stage lower limb lymphedema

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.

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.

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).

LVA was effective for advanced-stage lymphedema patients. An adequate preoperative examination with plural imaging methods seems helpful for achieving a successful surgical result.