Assi Drobot1, Maxim Bez2, Ibrahim Abu Shakra1, Fahed Merei1, Kamal Khatib1, Amitai Bickel3, Samer Ganam1, Grigori Bogouslavski1, Nour Karra1, Badran Mahran1, Walid Kassis1, Leonid Kogan1, Denis Drobot1, Michael Weiss1, Isao Koshima4, Eli Kakiashvili5. 1. Department of Surgery A, Galilee Medical Center, Nahariya, Israel; Faculty of Medicine of the Galilee, Bar-Ilan University, Ramat Gan, Israel. 2. Medical Corps, Israel Defense Forces, Ramat Gan, Israel. 3. Department of Surgery A, Galilee Medical Center, Nahariya, Israel; Faculty of Medicine of the Galilee, Bar-Ilan University, Ramat Gan, Israel; Medical Corps, Israel Defense Forces, Ramat Gan, Israel. 4. International Center for Lymphedema, Hiroshima University Hospital, Hiroshima. 5. Department of Surgery A, Galilee Medical Center, Nahariya, Israel; Faculty of Medicine of the Galilee, Bar-Ilan University, Ramat Gan, Israel; Medical Corps, Israel Defense Forces, Ramat Gan, Israel. Electronic address: elik@gmc.gov.il.
Abstract
OBJECTIVE: The objective of this study was to evaluate the efficacy and safety of lymphaticovenular anastomosis (LVA) in patients with lymphedema. METHODS: A retrospective analysis was conducted of 70 patients suffering from primary or secondary lymphedema who underwent LVA surgery with indocyanine green fluorescence lymphangiography. Postoperative evaluation included qualitative and quantitative volumetric assessment and analysis. Limb volume was measured by circumferential tape measurement volumetric method, in which the limb is subdivided into five segments and each segment's circumference is measured. RESULTS: LVA was performed in 70 patients, 22 with primary lymphedema and 48 with secondary lymphedema. The difference in preoperative upper limb volume was 35% with mean postoperative follow-up of 9 months. The mean number of lymphovenous bypasses was 3.9. The reduction in limb volume at 3, 6, and 12 months was 40.4%, 41%, and 45%, respectively. Patients with early-stage lymphedema had significantly higher volume reductions than patients with late-stage lymphedema at 3, 6, and 12 months (48% vs 18%, 49% vs 22%, and 65% vs 31%; P < .001). For lower extremity lymphedema, the preoperative volume differential was 25.5%. The mean postoperative follow-up was 9 months. The reduction in limb volume at 3, 6, and 12 months was 28%, 37%, and 39%, respectively. CONCLUSIONS: LVA surgery is a safe and effective method of reducing lymphedema severity, especially in upper extremity lymphedema at an earlier disease stage.
OBJECTIVE: The objective of this study was to evaluate the efficacy and safety of lymphaticovenular anastomosis (LVA) in patients with lymphedema. METHODS: A retrospective analysis was conducted of 70 patients suffering from primary or secondary lymphedema who underwent LVA surgery with indocyanine green fluorescence lymphangiography. Postoperative evaluation included qualitative and quantitative volumetric assessment and analysis. Limb volume was measured by circumferential tape measurement volumetric method, in which the limb is subdivided into five segments and each segment's circumference is measured. RESULTS: LVA was performed in 70 patients, 22 with primary lymphedema and 48 with secondary lymphedema. The difference in preoperative upper limb volume was 35% with mean postoperative follow-up of 9 months. The mean number of lymphovenous bypasses was 3.9. The reduction in limb volume at 3, 6, and 12 months was 40.4%, 41%, and 45%, respectively. Patients with early-stage lymphedema had significantly higher volume reductions than patients with late-stage lymphedema at 3, 6, and 12 months (48% vs 18%, 49% vs 22%, and 65% vs 31%; P < .001). For lower extremity lymphedema, the preoperative volume differential was 25.5%. The mean postoperative follow-up was 9 months. The reduction in limb volume at 3, 6, and 12 months was 28%, 37%, and 39%, respectively. CONCLUSIONS: LVA surgery is a safe and effective method of reducing lymphedema severity, especially in upper extremity lymphedema at an earlier disease stage.
Authors: Erik M Verhey; Lyndsay A Kandi; Yeonsoo S Lee; Bryn E Morris; William J Casey; Alanna M Rebecca; Lisa A Marks; Michael A Howard; Chad M Teven Journal: Plast Reconstr Surg Glob Open Date: 2022-10-07