Efficacy and patient satisfaction regarding lymphovenous bypass with sleeve-in anastomosis for extremity lymphedema

Background When performing lymphovenous anastomosis, it is sometimes difficult to find venules in the proximity of an ideal lymphatic vessel that have a similar diameter to that of the lymphatic vessel. In this situation, larger venules can be used.

Methods The authors evaluated the efficacy of and patient satisfaction with lymphovenous bypass with sleeve-in anastomosis. Between January 2014 and December 2016, we performed this procedure in 18 patients (eight upper extremities and 10 lower extremities) with secondary lymphedema. Lymphovenous bypass with sleeve-in anastomosis was performed under microscopy after injecting indocyanine green dye. The circumferential diameter was measured before lymphovenous bypass and at 1, 2, and 6 months after the procedure. An outcomes survey that included patients’ qualitative satisfaction with lymphovenous bypass was conducted at 6 months postoperatively.

Results Almost all patients showed quantitative improvements after surgery. The circumferential reduction rate in patients with stage II lymphedema of both the upper and lower extremities was significantly greater than in their counterparts with stage III/IV lymphedema. The circumferential reduction rate was lower in lower-extremity patients than in upper-extremity patients.

Conclusions Lymphovenous bypass surgery with sleeve-in anastomosis in lymphedema patients is beneficial, and appears to be effective, when adequately-sized venules cannot be found in the proximity of an ideal lymphatic vessel.

Keywords

Lymphedema - Microsurgery - Lower extremity - Upper extremity

Publication History

Received: 03 July 2018

Accepted: 14 December 2018

Article published online:
28 March 2022

• REFERENCES

• 1 Campisi C. Lymphoedema: modern diagnostic and therapeutic aspects. Int Angiol 1999; 18: 14-24
• 2 Sakorafas GH, Peros G, Cataliotti L. et al. Lymphedema following axillary lymph node dissection for breast cancer. Surg Oncol 2006; 15: 153-65
• 3 O’Brien BM, Chait LA, Hurwitz PJ. Microlymphatic surgery. Orthop Clin North Am 1977; 8: 405-24
• 4 Koshima I, Inagawa K, Urushibara K. et al. Paraumbilical perforator flap without deep inferior epigastric vessels. Plast Reconstr Surg 1998; 102: 1052-7
• 5 Lasso JM, Perez Cano R. Practical solutions for lymphaticovenous anastomosis. J Reconstr Microsurg 2013; 29: 1-4
• 6 O’Brien BM, Mellow CG, Khazanchi RK. et al. Long-term results after microlymphaticovenous anastomoses for the treatment of obstructive lymphedema. Plast Reconstr Surg 1990; 85: 562-72
• 7 Koshima I, Nanba Y, Tsutsui T. et al. Long-term follow-up after lymphaticovenular anastomosis for lymphedema in the leg. J Reconstr Microsurg 2003; 19: 209-15
• 8 Auba C, Marre D, Rodriguez-Losada G. et al. Lymphaticovenular anastomoses for lymphedema treatment: 18 months postoperative outcomes. Microsurgery 2012; 32: 261-8
• 9 Yamamoto Y, Horiuchi K, Sasaki S. et al. Follow-up study of upper limb lymphedema patients treated by microsurgical lymphaticovenous implantation (MLVI) combined with compression therapy. Microsurgery 2003; 23: 21-6
• 10 Chang DW, Suami H, Skoracki R. A prospective analysis of 100 consecutive lymphovenous bypass cases for treatment of extremity lymphedema. Plast Reconstr Surg 2013; 132: 1305-14
• 11 Koshima I, Inagawa K, Urushibara K. et al. Supermicrosurgical lymphaticovenular anastomosis for the treatment of lymphedema in the upper extremities. J Reconstr Microsurg 2000; 16: 437-42
• 12 Huang GK, Hu RQ, Liu ZZ. et al. Microlymphaticovenous anastomosis in the treatment of lower limb obstructive lymphedema: analysis of 91 cases. Plast Reconstr Surg 1985; 76: 671-85
• 13 Franks PJ, Moffatt CJ, Doherty DC. et al. Assessment of health-related quality of life in patients with lymphedema of the lower limb. Wound Repair Regen 2006; 14: 110-8
• 14 Nagase T, Gonda K, Inoue K. et al. Treatment of lymphedema with lymphaticovenular anastomoses. Int J Clin Oncol 2005; 10: 304-10
• 15 Yamamoto T, Narushima M, Doi K. et al. Characteristic indocyanine green lymphography findings in lower extremity lymphedema: the generation of a novel lymphedema severity staging system using dermal backflow patterns. Plast Reconstr Surg 2011; 127: 1979-86
• 16 Lee YJ, Park JI, Han HS. et al. Treatment of the lymphedema using microlymphaticovenous anastomoses: two cases. J Korean Soc Plast Reconstr Surg 1992; 19: 1041-8
• 17 Puckett CL, Jacobs GR, Hurvitz JS. et al. Evaluation of lymphovenous anastomoses in obstructive lymphedema. Plast Reconstr Surg 1980; 66: 116-20