Efficacy and patient satisfaction regarding lymphovenous bypass with sleeve-in anastomosis for extremity lymphedema

Abstract

Background When performing lymphovenous anastomosis, it is sometimes difficult to find venules in the proximity of an ideal lymphatic vessel that have a similar diameter to that of the lymphatic vessel. In this situation, larger venules can be used. Methods The authors evaluated the efficacy of and patient satisfaction with lymphovenous bypass with sleeve-in anastomosis. Between January 2014 and December 2016, we performed this procedure in 18 patients (eight upper extremities and 10 lower extremities) with secondary lymphedema. Lymphovenous bypass with sleeve-in anastomosis was performed under microscopy after injecting indocyanine green dye. The circumferential diameter was measured before lymphovenous bypass and at 1, 2, and 6 months after the procedure. An outcomes survey that included patients’ qualitative satisfaction with lymphovenous bypass was conducted at 6 months postoperatively. Results Almost all patients showed quantitative improvements after surgery. The circumferential reduction rate in patients with stage II lymphedema of both the upper and lower extremities was significantly greater than in their counterparts with stage III/IV lymphedema. The circumferential reduction rate was lower in lower-extremity patients than in upper-extremity patients. Conclusions Lymphovenous bypass surgery with sleeve-in anastomosis in lymphedema patients is beneficial, and appears to be effective, when adequately-sized venules cannot be found in the proximity of an ideal lymphatic vessel.

Correlation between patency and clinical improvement after lymphaticovenous anastomosis (LVA) in breast cancer-related lymphedema: 12-month follow-up

“…Many studies stated that LVA was less effective in advanced lymphedema and in patients presenting ICG stage IV or more [39][40][41][42][43]. Similarly, the current study illustrated a lower patency rate in ISL stage IIB and in ICG stage IV (OR 0.3 and OR 0.1, respectively).…”

Systematic Review of Patient-Reported Outcomes following Surgical Treatment of Lymphedema

“…Three studies described creation of ad-hoc study specific tools. Chung et al created their own questionnaire in a retrospective study of 18 patients undergoing LVB for either upper or lower extremity lymphedema [31]. The questionnaire had eight questions, scored from 0 to 5, with higher scores being better than lower scores.…”

Lymphaticovenous Anastomosis for Lower Extremity Lymphedema: A Systematic Review

“…End-to-end (E-E) and sideto-end (S-E) anastomosis were the most frequently employed surgical techniques. A modified version of the E-E LVA, the sleeve-in technique, in which a lymphatic vessel is implanted into the lumen of a vein, was used by Yamamoto and Sugihara, 44 Olszewski, 28 and Chung et al 45 Yamamoto et al 46 introduced the l-shaped anastomosis with intravascular stent (IVaS) method for cases in which only one lymphatic channel and one venule could be found. They suggested identifying vessels appropriate for anastomosis and transecting them.…”

“…An out-to-in transluminal suture is placed through a vein with a large diameter, followed by an in-to-out transluminal suture, which intussuscepts all the lymphatic vessels into the vein, and forms an LVA complex that resembles an octopus. 50 Per case 1 29,30,36,[51][52][53] to 18 46 anastomoses were performed, and it took an average of 3 to 4 hours 29,35,[44][45][46][54][55][56][57][58] for surgeons to perform the entire procedure. Follow-up time ranged from 1 59,60 to 87 months.…”

“…Patients' satisfaction after LVA has been also evaluated. Chung et al 45 found moderate scores of satisfaccion after treatment. Moreover, improvement in the quality of life has been demonstrated after LVA during the first postoperative months.…”