Indication of Lymphaticovenous Anastomosis for Lower Limb Primary Lymphedema

Hara, Hisako; Mihara, Makoto; Ohtsu, Hiroshi; Narushima, Mitsunaga; Iida, Takuya; Koshima, Isao

doi:10.1097/prs.0000000000001631

Cited by 68 publications

(62 citation statements)

References 25 publications

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“…(Carl et al, ; Garza 3rd et al, ; Kung, Champaneria, Maki, & Neligan, ) Physiologic procedures have yielded effective and enduring results in the treatment of both primary and secondary lymphedema (Boccardo et al, ; Campisi et al, ). Its efficacy in primary lymphedema, however, is controversial (Beaulac, McNair, Scott, LaMorte, & Kavanah, ; Chang, ; Demirtas, Ozturk, Yapici, & Topalan, ; Gloviczki et al, ; Grant et al, ; Hara et al, ). Some authors still recommend excisional over physiologic procedures for primary lymphedema treatment, as they have more predictable results and are applicable to all patients (Goldsmith, ; Grant et al, ; Miller, Wyatt, & Rudkin, ; O'Brien et al, ).…”

Section: Discussionmentioning

confidence: 99%

Comparisons in long‐term clinical outcomes among patients with upper or lower extremity lymphedema treated with diverse vascularized lymph node transfer

et al. 2019

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Background Vascularized lymph node transfer (VLNT) is an emerging surgical treatment for lymphedema. However, literature‐comparing outcomes of upper limb lymphedema (ULL) and lower limb lymphedema (LLL) is limited. Hence, the aim of this study is to compare the long‐term clinical outcomes on ULL versus LLL in patients treated with VLNT. Methods A retrospective study retrieving data from patients with International Society of Lymphology (ISL) stages II–III who underwent different VLNTs from July 2010 to July 2016 in our institution was performed. Demographics preoperatively, and clinical data (limb circumference, infectious episodes, lymphoscintigraphic studies) preoperatively and postoperatively were recorded. Clinical outcomes by extremity were also analyzed. Results A total of 83 patients with lymphedema (ULL: n = 30, LLL: n = 53) were included. Mean follow‐up time was 32.8 months (range 24–49 months). Mean circumference reduction was higher in patients with ULL compared to with LLL (28.6 ± 8.6 vs. 22.3 ± 10.1, p < .001), and for patients with secondary lymphedema (24.8 ± 9.6, p < .001) than for patients with primary lymphedema (18.9 ± 14, p > .05). Infectious episodes per year preoperative and postoperative showed that LLL patients had higher reduction on infection rate compared with ULL patients (2.4 ± 1.1 vs. 1.9 ± 1.2, p < .001). Conclusion VLNT is a promising surgical treatment option for patients with lymphedema. This study suggests that VLNT may have a more beneficial outcome in patients with ULL and with secondary lymphedema.

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Section: Discussionmentioning

confidence: 99%

Comparisons in long‐term clinical outcomes among patients with upper or lower extremity lymphedema treated with diverse vascularized lymph node transfer

et al. 2019

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“…The most common method for creating an alternative outflow is by utilizing the venous circulation, which has the capacity to accommodate the additional fluid load. Most physiologic methods have been used for secondary lymphedema, but some have reported benefit when these procedures are used in primary lymphedema [72]. …”

Section: Management Strategiesmentioning

confidence: 99%

A comprehensive overview on the surgical management of secondary lymphedema of the upper and lower extremities related to prior oncologic therapies

Garza¹,

Skoracki²,

Hock³

et al. 2017

BMC Cancer

117

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Secondary lymphedema of the upper and lower extremities related to prior oncologic therapies, including cancer surgeries, radiation therapy, and chemotherapy, is a major cause of long-term morbidity in cancer patients. For the upper extremities, it is most commonly associated with prior oncologic therapies for breast cancer, while for the lower extremities, it is most commonly associated with oncologic therapies for gynecologic cancers, urologic cancers, melanoma, and lymphoma. Both non-surgical and surgical management strategies have been developed and utilized, with the primary goal of all management strategies being volume reduction of the affected extremity, improvement in patient symptomology, and the reduction/elimination of resultant extremity-related morbidities, including recurrent infections. Surgical management strategies include: (i) ablative surgical methods (i.e., Charles procedure, suction-assisted lipectomy/liposuction) and (ii) physiologic surgical methods (i.e., lymphaticolymphatic bypass, lymphaticovenular anastomosis, vascularized lymph node transfer, vascularized omental flap transfer). While these surgical management strategies can result in dramatic improvement in extremity-related symptomology and improve quality of life for these cancer patients, many formidable challenges remain for successful management of secondary lymphedema. It is hopeful that ongoing clinical research efforts will ultimately lead to more complete and sustainable treatment strategies and perhaps a cure for secondary lymphedema and its devastating resultant morbidities.

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“…22 Of note, they report that the diameter of the lymphatic vessels and venules in the pediatric population were greater than 0.3 mm in diameter, and therefore overall not smaller than findings in their adult population. 22 In the physiologic category of extremity lymphedema treatment, all studies discussing vascularized lymph node transfer (VLNT) in the pediatric population were excluded due to small sample size or inability to extract the pediatric data from what was reported. One case series reporting one pediatric patient with congenital lymphedema described VLNT from the thoracodorsal axis.…”

Section: Discussionmentioning

confidence: 84%

Surgical Management of Pediatric Lymphedema: A Systematic Review

Kanth

Krevalin

Adetayo

et al. 2019

J reconstr Microsurg

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Background Lymphedema is a rare, progressive, and debilitating condition caused by failure of the lymphatic system to adequately drain the protein-rich fluid exiting the capillaries. Conservative management is often emphasized in pediatric patients, resulting in a paucity of literature describing surgical treatment in this population. Methods A systematic review was performed using PubMed, ScienceDirect, and Google Scholar to identify all studies describing surgical management of lymphedema in the pediatric population. Results Of the 343 relevant articles identified, 14 met the criteria for full review. Articles were divided into the following treatment categories: genital lymphedema, excisional procedures for extremity lymphedema, and physiologic procedures for extremity lymphedema. Outcomes for genital lymphedema were overall positive. For extremity lymphedema, excisional procedures yielded good results overall and included the majority of patients in this study. Physiologic procedures had mixed outcomes in the small population included in this study, but definitive conclusions cannot be drawn due to the paucity of existing data. Conclusion While conservative management of pediatric lymphedema is well described, the literature remains sparse regarding surgical treatment. Further studies are needed to evaluate efficacy and outcomes in all three categories in this population.

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Indication of Lymphaticovenous Anastomosis for Lower Limb Primary Lymphedema

Abstract: Therapeutic, IV.

Cited by 68 publications

References 25 publications

Comparisons in long‐term clinical outcomes among patients with upper or lower extremity lymphedema treated with diverse vascularized lymph node transfer

Comparisons in long‐term clinical outcomes among patients with upper or lower extremity lymphedema treated with diverse vascularized lymph node transfer

A comprehensive overview on the surgical management of secondary lymphedema of the upper and lower extremities related to prior oncologic therapies

Surgical Management of Pediatric Lymphedema: A Systematic Review

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