Prevention of venous reflux with full utilization of venoplasty in lymphaticovenular anastomosis

Akita, Shinsuke; Yamaji, Yoshihisa; Tokumoto, Hideki; Maei, Haruka; Tezuka, Takafumi; Ogata, Hideyuki; Kosaka, Kentaro; Kubota, Yoshitaka; Kuriyama, Masafumi; Mitsukawa, Nobuyuki

doi:10.1016/j.bjps.2019.10.020

Cited by 13 publications

(10 citation statements)

References 31 publications

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“…Fifteen of the eligible studies noted either partial or complete reductions in episodes of cellulitis postoperatively. 16,25,27,29,31,35,36,51,54,56,57,61,67,84,86 Of particular importance, Cha et al 16 reported that even in patients with advanced stage lymphedema with a paucity of functional lymphatics, the incidence of cellulitis per year decreased from 0.84 to 0.07 after LVA. Yoshida et al 35 reported that of the 31 patients in a 113-patient cohort who experienced episodes of cellulitis preoperatively, none experienced cellulitis after LVA.…”

Section: Resultsmentioning

confidence: 99%

“…While most studies evaluated only variations of LVA and its primary outcomes, several investigated the outcomes of the so-called stacked procedures, or LVA in addition to another intervention. These additional procedures included superficial and deep LVA, 22 great saphenous vein stripping, 23 lymph node to vein anastomosis, 21 venoplasty, 27 vascularized lymph node transplantation, 29,58 vein grafting, 64 and lymphovenous implantation. 84 Intraoperatively, nearly 75% of studies used of indocyanine green (ICG) lymphography for detection of superficial lymphatics and to assess lymphatic function.…”

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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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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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“…Thirteen articles reporting surgical complications of LVA were identified (see Supplementary Table S1 [available in the online version], which displays an overview of the included studies). 12 13 14 15 16 17 18 19 20 21 22 23 A summary of the reported complications is exhibited in Table 1 . The most common complications reported were re-exploration of the anastomosis ( n = 22, 36.6%), venous reflux ( n = 15, 24.6%), cellulitis or abscess ( n = 9, 14.75%), seroma formation ( n = 4, 6.55%), and lymphatic fluid leakage ( n = 2, 3.27%).…”

Section: Resultsmentioning

confidence: 99%

Lessons Learnt from an 11-year Experience with Lymphatic Surgery and a Systematic Review of Reported Complications: Technical Considerations to Reduce Morbidity

et al. 2022

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Complications experienced during lymphatic surgery have not been ubiquitously reported, and little has been described regarding how to prevent them. We present a review of complications reported during the surgical management of lymphedema and our experience with technical considerations to reduce morbidity from lymphatic surgery. A comprehensive search across different databases was conducted through November 2020. Based on the complications identified, we discussed the best approach for reducing the incidence of complications during lymphatic surgery based on our experience. The most common complications reported following lymphovenous anastomosis were re-exploration of the anastomosis, venous reflux, and surgical site infection. The most common complications using groin vascularized lymph node transfer (VLNT), submental VLNT, lateral thoracic VLNT, and supraclavicular VLNT included delayed wound healing, seroma and hematoma formation, lymphatic fluid leakage, iatrogenic lymphedema, soft-tissue infection, venous congestion, marginal nerve pseudoparalysis, and partial flap loss. Regarding intra-abdominal lymph node flaps, incisional hernia, hematoma, lymphatic fluid leakage, and postoperative ileus were commonly reported. Following suction-assisted lipectomy, significant blood loss and transient paresthesia were frequently reported. The reported complications of excisional procedures included soft-tissue infections, seroma and hematoma formation, skin-graft loss, significant blood loss, and minor skin flap necrosis. Evidently, lymphedema continues to represent a challenging condition; however, thorough patient selection, compliance with physiotherapy, and an experienced surgeon with adequate understanding of the lymphatic system can help maximize the safety of lymphatic surgery.

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“…29 • Valvuloplasty: many different valvuloplasty techniques have been described but, in our hands, they are not effective in obtaining a favorable flow dynamic. Reports on their effectiveness are present, 30 and this option may be considered when no favorable veins can be brought to the incision site. Scenario 3.…”

Section: Features Of the Recipient Venulesmentioning

confidence: 99%

Recipient Venule Selection and Anastomosis Configuration for Lymphaticovenular Anastomosis in Extremity Lymphedema: Algorithm Based on 1,000 Lymphaticovenular Anastomosis

Bianchi

Salgarello

Hayashi

et al. 2021

J Reconstr Microsurg

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Background The lymphaticovenular anastomosis (LVA) has three components, lymphatics, venules, and anastomosis, and all of them influence the anastomotic pressure gradient. Although it has been demonstrated that venule flow dynamics has an independent impact on the outcomes regardless the degeneration status of lymphatic vessels, recipient venules (RV) have been mainly neglected in literature. Patients and Methods From January 2016 to February 2020, 232 nonconsecutive patients affected by extremity lymphedema underwent LVA, for a total of 1,000 LVAs. Only patients with normal-to-ectasic lymphatic collectors were included to focus the evaluation on the RV only. The preoperative collected data included the location, diameter, and continence of the selected venules, the expected number, the anastomoses configuration, and their flow dynamics according to BSO classification. Results The 232 patients included 117 upper limb lymphedema (ULL) and 115 lower limb lymphedema (LLL). The average size of RV was 0.81 ± 0.32 mm in end-to-end (E-E), 114 ± 0.17 mm in end-to-side (E-S), 0.39 ± 0.22 mm in side-to-end (S-E), and 0.76 ± 0.38 mm in side-to-side (S-S) anastomoses. According to the BSO classification, on a total of 732 RV, 105(14%) were backflow venules, 136 (19%) were slack, and 491 (67%) were outlet venules. Also, 824 (82%) were E-E, 107 (11%) were E-S, 51 (5%) were S-E, and 18 (2%) were S-S anastomoses. Conclusion Based on 1,000 LVAs with similar lymphatic characteristics, we propose our algorithm that may aid the lymphatic microsurgeon in the selection of RV and the consequent anastomosis configuration, in order of obtain the best flow dynamic through the LVA. This therapeutic study reflects level of evidence IV.

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Prevention of venous reflux with full utilization of venoplasty in lymphaticovenular anastomosis

Cited by 13 publications

References 31 publications

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

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

Lessons Learnt from an 11-year Experience with Lymphatic Surgery and a Systematic Review of Reported Complications: Technical Considerations to Reduce Morbidity

Recipient Venule Selection and Anastomosis Configuration for Lymphaticovenular Anastomosis in Extremity Lymphedema: Algorithm Based on 1,000 Lymphaticovenular Anastomosis

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