Decompression of Axillary Vein: An Essential Adjunct for Advanced Lymphedema

Area of Science:

• Vascular Surgery
• Lymphedema Management
• Microsurgery

Background:

• Advanced lymphedema treatment often involves lymphovenous anastomosis (LVA), which relies on pressure gradients between lymphatic and venous systems.
• High venous pressure can limit the effectiveness of LVA surgery.
• The impact of axillary vein perivascular scar release on LVA outcomes requires further investigation.

Purpose of the Study:

• To evaluate the effect of axillary vein perivascular scar release on lymphovenous anastomosis (LVA) outcomes in patients with advanced lymphedema.
• To determine if scar release improves the pressure gradient for better lymphatic fluid outflow.

Main Methods:

• A retrospective study involving 40 patients with upper limb lymphedema (stage 2 and 3) undergoing LVA.
• Patients were divided into a scar release group (n=25) and a control group (n=15).
• Evaluated outcomes included volumetric changes, bioimpedance analysis (BIA), and major vein diameter changes over a mean follow-up of 33 months.

Main Results:

• Both groups showed significant volume and BIA reductions post-LVA.
• The scar release group demonstrated statistically superior BIA reduction at 1, 6, and 12 months compared to the control group.
• Axillary scar release led to significant changes in axillary, basilic, and cephalic vein diameters, with a correlation between cephalic vein diameter reduction and BIA measurements.

Conclusions:

• Release of perivascular scar tissue in the axillary vein may enhance LVA outcomes.
• Scar release potentially reduces venous pressure, increasing the lymphatic-venous pressure gradient and improving lymphatic outflow.
• This suggests scar release is a valuable adjunct for optimizing LVA in lymphedema treatment.