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

Background: Lymphaticovenular anastomosis (LVA) with supramicrosurgical technique has recently gained popularity as a treatment method for patients with lymphedema. The aim of this study was to prospectively evaluate objective changes in leg volume in patients operated with LVA for lymphedema in the lower extremity, and to find positive predictors for the treatment method to facilitate the location of the venules and lymphatic vessels.

Patients & methods: 31 consecutive patients with lymphedema in the lower extremity and positive pitting test were examined with lymphoscintigraphy and indocyanine green (ICG) lymphography. The causes of the lymphedema were either cancer or unknown cause/primary lymphedema. Fourteen of the patients with pathological lymphangiographic patterns were chosen for surgery and 12 of them were operated with one to four LVAs each. The lymphedema volume in the lower extremity was measured preoperatively, 6- and 12 months after surgery according to the truncated cone formula with the patient´s contralateral leg used as control. Ten patients had unilateral lymphedema and two patients had bilateral lymphedema.

Results: Five of 12 patients showed between 1-8% edema reductions in the lower extremity after 12 months. With examination considering edema duration, number of anastomoses, radiotherapy and lymph node dissection we found a 6,2% difference in edema reduction between patients who had undergone lymph node dissection and those who had not (p = 0.03).

Conclusions: The current study indicates that supramicrosurgery with LVA may reduce edema volumes, where the most distinctive positive predictor for edema reduction with LVAs was previous lymph node dissection.