Multi-site lymphatic venous anastomosis using echography to detect suitable subcutaneous vein in severe lymphedema patients

Mihara, Makoto; Hara, Hisako; Kawakami, Yukikiyo; Zhou, Hang Peng; Tange, Shuichi; Kazuki, Kenichi; Iida, Takuya

doi:10.1016/j.bjps.2017.10.004

Cited by 26 publications

(20 citation statements)

References 27 publications

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“…Lymphedema exacerbation was reported in 23.8% of the patients from the control group, while only 5.9% from the echo group experienced lymphedema deterioration. 34 In patients with lymphedema onset before 11 years of age, Hara et al 58 reported aggravation of their condition. Positive outcomes were seen more often in those with onset after 11 years of age.…”

Section: Resultsmentioning

confidence: 99%

“…Campisi's lymphedema grading system 32 was used in 12 studies, while the Yamamoto classification system 33 based on lymphatic dermal backflow patterns seen on indocyanine green lymphography (ICG-L) was used in 17 studies. Mihara et al, 34 Akita et al, 35 and Maegawa et al 36 used the grading system based on lymphoscintigraphy findings, described by Maegawa et al 37 in one of their earlier reports. Ito and collegues 38 used Cheng's classification system 39 and Olszewski 28 used a grading system based on evaluation of the level of edema embracing the limb from foot to groin and the advancement of skin keratosis and fibrosis.…”

Section: Resultsmentioning

confidence: 99%

“…Regarding outcomes, Gloviczki and collegues 41 reported improvement in only two of eight patients, while four patients reported worsening of lymphedema. Mihara et al 34 compared LVA outcomes in the following two groups of patients: those in whom noncontact vein visualizing system was used to detect subcutaneous veins (control group) versus those in whom venous echography was used (echo group). Lymphedema exacerbation was reported in 23.8% of the patients from the control group, while only 5.9% from the echo group experienced lymphedema deterioration.…”

Section: Resultsmentioning

confidence: 99%

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Lymphaticovenous Anastomosis for Lower Extremity Lymphedema: A Systematic Review

Forte

Khan

Huayllani

et al. 2020

Indian J Plast Surg

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Background Lymphedema is an accumulation of protein-rich fluid in the interstitial spaces resulting from impairment in the lymphatic circulation that can impair quality of life and cause considerable morbidity. Lower extremity lymphedema (LEL) has an overall incidence rate of 20%. Conservative therapies are the first step in treatment of LEL; however, they do not provide a cure because they fail to address the underlying physiologic dysfunction of the lymphatic system. Among several surgical alternatives, lymphaticovenous anastomosis (LVA) has gained popularity due to its improved outcomes and less invasive approach. This study aims to review the published literature on LVA for LEL treatment and to analyze the surgical outcomes. Methods PubMed database was used to perform a comprehensive literature review of all articles describing LVA for treatment of LEL from Novemeber 1985 to June 2019. Search terms included “lymphovenous” OR “lymphaticovenous” AND “bypass” OR “anastomosis” OR “shunt” AND “lower extremity lymphedema.” Results A total of 95 articles were identified in the initial query, out of which 58 individual articles were deemed eligible. The studies included in this review describe notable variations in surgical techniques, number of anastomoses, and supplementary interventions. All, except one study, reported positive outcomes based on limb circumference and volume changes or subjective clinical improvement. The largest reduction rate in limb circumference and volume was 63.8%. Conclusion LVA demonstrated a considerable reduction in limb volume and improvement in subjective findings of lymphedema in the majority of patients. The maintained effectiveness of this treatment modality in long-term follow-up suggests great efficacy of LVA in LEL treatment.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Lymphaticovenous Anastomosis for Lower Extremity Lymphedema: A Systematic Review

Forte

Khan

Huayllani

et al. 2020

Indian J Plast Surg

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“…Advances in microsurgical techniques and an improved understanding of the pathophysiology of lymphedema have led to the development of a variety of surgical options for the treatment of secondary lymphedema [1][2][3][4][5]. However, although numerous investigators have published outcomes following lymphovenous bypass [6][7][8][9], vascularized lymph node transplantation [2,3,[10][11][12][13][14], and liposuction [5,15], a detailed discussion of the assessment of prospective surgical candidates has not been reported. As a result, there are currently many preoperative assessment protocols complicating comparison of outcomes between centers [16][17][18][19][20][21][22].…”

Section: Introductionmentioning

confidence: 99%

Preoperative Assessment of Upper Extremity Secondary Lymphedema

Wiser

Mehrara

Coriddi

et al. 2020

Cancers

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Introduction: The purpose of this study was to evaluate the most commonly used preoperative assessment tools for patients undergoing surgical treatment for secondary upper extremity lymphedema. Methods: This was a prospective cohort study performed at a tertiary cancer center specializing in the treatment of secondary lymphedema. Lymphedema evaluation included limb volume measurements, bio-impedance, indocyanine green lymphography, lymphoscintigraphy, magnetic resonance angiography, lymphedema life impact scale (LLIS) and upper limb lymphedema 27 (ULL-27) questionnaires. Results: 118 patients were evaluated. Limb circumference underestimated lymphedema compared to limb volume. Bioimpedance (L-Dex) scores highly correlated with limb volume excess (r2 = 0.714, p < 0.001). L-Dex scores were highly sensitive and had a high positive predictive value for diagnosing lymphedema in patients with a volume excess of 10% or more. ICG was highly sensitive in identifying lymphedema. Lymphoscintigraphy had an overall low sensitivity and specificity for the diagnosis of lymphedema. MRA was highly sensitive in diagnosing lymphedema and adipose hypertrophy as well as useful in identifying axillary vein obstruction and occult metastasis. Patients with minimal limb volume difference still demonstrated significantly impaired quality of life. Conclusion: Preoperative assessment of lymphedema is complex and requires multimodal assessment. MRA, L-Dex, ICG, and PROMs are all valuable components of preoperative assessment.

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“…Other techniques that have been described for localization of the veins include ultrasonography or echography, which can certainly enhance and facilitate the LVA procedure. 24,25 However, while there may be benefits of the use of additional imaging technologies for identifying both the veins and the lymphatics for performing an LVB, the only critical imaging modality that has been agreed upon by surgeons who perform high-volume lymphedema surgeries is ICG. [26][27][28]…”

mentioning

confidence: 99%

Lymphovenous Anastomosis Bypass Surgery

Chang

Skoracki

Chang

2018

Seminars in Plastic Surgery

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The field of lymphedema surgery has witnessed tremendous advancements over the years and has been coupled to the rapid growth of supermicrosurgical techniques. A lymphovenous bypass or lymphaticovenular anastomosis is a new technique that requires identification of patent, residual lymphatic channels and performing an anastomosis to a recipient venule, thereby allowing outflow of lymphatic fluid and improvement in a patient's lymphedema. This article provides a summary of the maturation of the technique, as well as the technical aspects of the approach and the current outcomes in the treatment of postmastectomy lymphedema.

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Multi-site lymphatic venous anastomosis using echography to detect suitable subcutaneous vein in severe lymphedema patients

Cited by 26 publications

References 27 publications

Lymphaticovenous Anastomosis for Lower Extremity Lymphedema: A Systematic Review

Lymphaticovenous Anastomosis for Lower Extremity Lymphedema: A Systematic Review

Preoperative Assessment of Upper Extremity Secondary Lymphedema

Lymphovenous Anastomosis Bypass Surgery

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