Lymphatic Reconstructive Surgery in Primary and Secondary Lymphedema: A Comparative Outcome Study

Area of Science:

• Vascular Surgery
• Lymphedema Management
• Microsurgery

Background:

• Primary lymphedema (PLE) arises from lymphatic system maldevelopment.
• Current treatments for PLE often adapt strategies for secondary lymphedema (SLE).
• The efficacy of lymphovenous anastomosis (LVA) in PLE remains debated.

Purpose of the Study:

• To compare the effectiveness of LVA and vascularized lymph node transfer (VLNT) in treating primary and secondary lymphedema.
• To evaluate surgical outcomes based on limb volume changes.

Main Methods:

• Retrospective analysis of 48 limbs from patients with PLE or SLE undergoing LVA and/or VLNT (2016-2023).
• Preoperative and postoperative limb volumes were assessed.
• Outcomes were compared between different surgical approaches and combinations.

Main Results:

• VLNT alone was significantly more effective than LVA alone in reducing limb volume in PLE patients (P=0.035).
• VLNT (alone or combined with LVA) achieved volume reduction in 70% and 54.5% of patients, respectively, compared to 25% for LVA alone.
• Median limb volume reduction was 5.36% for VLNT in PLE and 7.98% in SLE, versus 3.46% for LVA in PLE and 3.72% in SLE.

Conclusions:

• Lymphovenous anastomosis (LVA) alone demonstrates lower efficacy than vascularized lymph node transfer (VLNT) alone for primary lymphedema.
• VLNT is recommended as the primary surgical approach for PLE.
• Intraoperative Indocyanine-green-angiography guidance is advised for deciding on additional LVA implementation.