Evaluation and selection of lower limb lymphedema patients for lymphaticovenular anastomosis: A prospective study

Kristiansen, Martina; Halle, Martin; Pignatti, Marco; Skogh, Ann-Charlott Docherty

doi:10.1016/j.injury.2020.02.110

Cited by 3 publications

(6 citation statements)

References 28 publications

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“…Lymphaticovenous anastomosis (LVA) has been the most frequently used operation technique to alleviate lymphedema by directly delivering lymphatic fluid into the venous system. [4][5][6] This promising microsurgical method requires precise anatomic information of lymph vessels for excision of nonfunctioning lymphatic segment and reconstruction of lymphatic drainage. 7 Lymphoscintigraphy is widely used as the main investigatory tool to confirm the lymphedema diagnosis, visualizing the functional status of the lymphatic system.…”

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confidence: 99%

Lymphoscintigraphic Findings as Indicators of Lymphaticovenous Anastomosis Outcome in Patients With Extremity Lymphedema

et al. 2021

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Purpose This study was performed to evaluate the usefulness of lymphoscintigraphy in predicting the surgical outcomes of lymphaticovenous anastomosis (LVA) in a patient with extremity lymphedema. Patients and Methods We retrospectively evaluated 133 patients with extremity lymphedema who underwent lymphoscintigraphy followed by LVA surgery from February 2018 to March 2020. Lymphoscintigraphic findings were evaluated on the following parameters: the extent of dermal backflow (small/large), lymphatic flow patterns (trunk flow pattern/proximal-restricted pattern/distal-restricted pattern), visualization of lymph nodes, and collateral lymphatic vessels. The mean circumferential difference change before and after surgery, circumferential reduction (CR) rate (%), was used as the clinical outcome variables. Results A decrease in circumference was observed in 93 (69.9%) of 133 patients after LVA. The extent of dermal backflow and lymphatic flow patterns was significantly correlated with improved clinical outcomes after LVA. The large extent of the dermal backflow group showed a more significant CR rate than the small extent (19.27% vs 1.24%, P = 0.005). The TP group showed the most significantly decreased CR rate to 21.46%, and the proximal-restricted pattern and distal-restricted pattern groups were −2.49% and −5.33%, respectively (P < 0.001). Multivariate analysis revealed that dermal backflow and lymphatic flow patterns were independent predictors of therapeutic outcome (P < 0.001). Conclusions Our study demonstrates that pretreatment lymphoscintigraphy may help predict the therapeutic effect of LVA in patients with extremity lymphedema. Furthermore, dermal backflow and lymphatic flow patterns are independent predictors of CR rate after LVA surgery for extremity lymphedema.

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confidence: 99%

Lymphoscintigraphic Findings as Indicators of Lymphaticovenous Anastomosis Outcome in Patients With Extremity Lymphedema

et al. 2021

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“…Overall, surgical complications were rare, and included a postoperative pelvic recurrence of lymphedema (one of 10 patients), 29 postoperative infection (two of 12 patients), 30 subcutaneous ecchymoses (six total patients across all studies), 32 , 71 , 78 cellulitis (a finding that is frequently seen in lymphedema patients before and after surgery), 67 lymphangitis (one of 26 patients), 84 and failed anastomoses (nine individual failed anastomoses in 48 patients and 80 total anastomoses). 75 While cellulitis appears to be the most common complication of LVA, followed distantly by postoperative ecchymosis, there were no reports whatsoever of any major complications such as donor site lymphedema, emergent need to return patients to the operating room, need for surgical revision, or patient death.…”

Section: Resultsmentioning

confidence: 99%

“…Studies were conducted retrospectively, other than 14 performed prospectively. 22,[28][29][30][31]42,47,52,[54][55][56]59,66,84 No randomized control trials (RCTs) were identified. Mean duration of lymphedema symptoms before treatment ranged from 12 months 29,65 to 11.4 years.…”

Section: Resultsmentioning

confidence: 99%

“…27,66,68,71,80 The remaining 41 studies included patients with either primary or secondary lymphedema. [16][17][18][19][20]22,24,[29][30][31][32][33][34][35][36]41,[43][44][45][46][50][51][52][54][55][56][57][58][59]61,67,72,75,76,78,81,82,84,85,88,89 Baseline and post-surgical lymphedema objective assessment were performed in various ways, including circumferential limb measurements in 34 studies, magnetic resonance volumetry in three studies, body weight in one study, body composition analysis (used to determine changes in extracellular fluid (ECF) volume) in one study, perometer limb volumetry in two studies, bioelectrical impedance in one study, computed tomography measurement of subcutaneous fat thickness in one study, lymphoscintigraphy in one study, ICG lymphography in three...…”

Section: Resultsmentioning

confidence: 99%

“…http://links.lww.com/PRSGO/C228). 16–89 Fifteen articles reported only the number of patients undergoing LVA, and did not specify the number of limbs. 17,20,38,43,44,49,52,55,56,62,67,72,78,87 Studies were published between 1996 89 and 2021 (Table 1).…”

Section: Resultsmentioning

confidence: 99%

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Outcomes of Lymphovenous Anastomosis for Lower Extremity Lymphedema: A Systematic Review

Verhey

Kandi

Lee

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Background: Lymphovenous anastomosis (LVA) is a microsurgical treatment for lymphedema of the lower extremity (LEL). This study systematically reviews the most recent data on outcomes of various LVA techniques for LEL in diverse patients. Methods: A comprehensive literature search was conducted in the Ovid MEDLINE, Ovid EMBASE, and Scopus databases to extract articles published through June 2021. Studies reporting data on objective postoperative improvement in lymphedema and/or subjective improvement in quality of life for patients with LEL were included. Extracted data comprised demographics, number of patients and lower limbs, duration of symptoms before LVA, surgical technique, duration of followup, and objective and subjective outcomes. Results: A total of 303 articles were identified and evaluated, of which 74 were ultimately deemed eligible for inclusion in this study, representing 6260 patients and 2554 lower limbs. The average patient age ranged from 22.6 to 76.14 years. The duration of lymphedema before LVA ranged from 12 months to 11.4 years. Objective rates of improvement in lymphedema ranged from 23.3% to 100%, with the greatest degree of improvement seen in patients with early-stage LEL. Conclusions: LVA is a safe and effective technique for the treatment of LEL of all stages. Several emerging techniques and variations may lead to improved patient outcomes.

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Outcomes after microsurgical treatment of lymphedema: a systematic review and meta-analysis

Meuli

Guiotto

Elmers

et al. 2023

International Journal of Surgery

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Background: Microsurgical treatment options for lymphedema consist mainly of lymphovenous anastomosis (LVA) and vascularized lymph node transfers (VLNTs). There are no standard measurements of the effectiveness of these interventions and reported outcomes vary among studies. Methods: A systematic review and meta-analysis were performed based on a structured search in Embase, Medline, PubMed, Cinahl, Cochrane, and ProQuest in October 2020, with an update in February 2022. Firstly, a qualitative summary of the main reported outcomes was performed, followed by a pooled meta-analysis of the three most frequently reported outcomes using a random effects model. Randomized controlled trials, prospective cohorts, retrospective cohorts, and cross-sectional and case–control studies that documented outcomes following microsurgery in adult patients were included. Studies of other surgical treatments (liposuction, radical excision, lymphatic vessel transplantation) or without reported outcomes were excluded. The study protocol was registered on PROSPERO (International Prospective Register of Systematic Reviews) (ID: CRD42020202417). No external funding was received for this review. Results: One hundred fifty studies, including 6496 patients, were included in the systematic review. The qualitative analysis highlighted the three most frequently reported outcomes: change in circumference, change in volume, and change in the number of infectious episodes per year. The overall pooled change in excess circumference across 29 studies, including 1002 patients, was −35.6% [95% CI: −30.8 to −40.3]. The overall pooled change in excess volume across 12 studies including 587 patients was −32.7% [95% CI: −19.8 to −45.6], and the overall pooled change in the number of cutaneous infections episodes per year across 8 studies including 248 patients was −1.9 [95% CI: −1.4 to −2.3]. The vast majority of the studies included were case series and cohorts, which were intrinsically exposed to a risk of selection bias. Conclusion: The currently available evidence supports LVA and vascularized lymph node transfers as effective treatments to reduce the severity of secondary lymphedema. Standardization of staging method, outcomes measurements, and reporting is paramount in future research in order to allow comparability across studies and pooling of results.

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Evaluation and selection of lower limb lymphedema patients for lymphaticovenular anastomosis: A prospective study

Cited by 3 publications

References 28 publications

Lymphoscintigraphic Findings as Indicators of Lymphaticovenous Anastomosis Outcome in Patients With Extremity Lymphedema

Lymphoscintigraphic Findings as Indicators of Lymphaticovenous Anastomosis Outcome in Patients With Extremity Lymphedema

Outcomes of Lymphovenous Anastomosis for Lower Extremity Lymphedema: A Systematic Review

Outcomes after microsurgical treatment of lymphedema: a systematic review and meta-analysis

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