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

Overview

Journal Plast Reconstr Surg Glob Open

Specialty General Surgery

Date 2022 Oct 13

PMID 36225843

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

Affiliations

Soon will be listed here.

Abstract

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 follow-up, 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.

Citing Articles

Advances in surgical management of chronic lymphedema: current strategies and future directions.

Sanka S, Chryssofos S, Anolik R, Sacks J Med Oncol. 2025; 42(2):44.

PMID: 39806245 PMC: 11729126. DOI: 10.1007/s12032-024-02576-2.

Prevalence of lower extremity edema following inguinal lymphadenectomy: A systematic review and meta-analysis.

Hahn B, Richir M, Witkamp A, de Jong T, Krijgh D JPRAS Open. 2025; 43:187-199.

PMID: 39758212 PMC: 11699470. DOI: 10.1016/j.jpra.2024.11.001.

Lymphovenous Bypass as an Alternative Strategy for Managing Phleboedema and Venous Leg Ulcers: Preliminary Results.

Chao S, Kuan C, Lin Y, Tai H, Cheng N Plast Reconstr Surg Glob Open. 2024; 12(8):e6064.

PMID: 39148508 PMC: 11326461. DOI: 10.1097/GOX.0000000000006064.

Effects of Lymphaticovenous Anastomosis on Quality of Life, Body Image, and Spiritual Health in Lymphedema Patients: A Prospective Cohort Study.

Peng S, Huang C, Shih C, Tsai P, Yang J, Hsieh C Healthcare (Basel). 2024; 12(14).

PMID: 39057563 PMC: 11276612. DOI: 10.3390/healthcare12141419.

[Cost comparison of conservative vs. surgical treatment of chronic lymphedema].

Nuwayhid R, Langer S, von Dercks N Chirurgie (Heidelb). 2024; 96(1):41-47.

PMID: 38940836 PMC: 11729079. DOI: 10.1007/s00104-024-02123-9.

References

Yoshida S, Koshima I, Imai H, Uchiki T, Sasaki A, Fujioka Y . Modified intraoperative distal compression method for lymphaticovenous anastomosis with high success and a low venous reflux rates. J Plast Reconstr Aesthet Surg. 2021; 74(9):2050-2058. DOI: 10.1016/j.bjps.2020.12.103. View

Campisi C, Ryan M, Boccardo F, Campisi C . A Single-Site Technique of Multiple Lymphatic-Venous Anastomoses for the Treatment of Peripheral Lymphedema: Long-Term Clinical Outcome. J Reconstr Microsurg. 2015; 32(1):42-9. DOI: 10.1055/s-0035-1549163. View

Drobot A, Bez M, Abu Shakra I, Merei F, Khatib K, Bickel A . Microsurgery for management of primary and secondary lymphedema. J Vasc Surg Venous Lymphat Disord. 2020; 9(1):226-233.e1. DOI: 10.1016/j.jvsv.2020.04.025. View

Maegawa J, Yabuki Y, Tomoeda H, Hosono M, Yasumura K . Outcomes of lymphaticovenous side-to-end anastomosis in peripheral lymphedema. J Vasc Surg. 2012; 55(3):753-60. DOI: 10.1016/j.jvs.2011.08.062. View

Yamamoto T, Narushima M, Doi K, Oshima A, Ogata F, Mihara M . 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(5):1979-1986. DOI: 10.1097/PRS.0b013e31820cf5df. View

Ciudad P, Sabbagh M, Agko M, Huang T, Manrique O, L C . Surgical Management of Lower Extremity Lymphedema: A Comprehensive Review. Indian J Plast Surg. 2019; 52(1):81-92. PMC: 6664851. DOI: 10.1055/s-0039-1688537. View

Koshima I, Yoshida S, Nagamatsu S, Yokota K, Mizuta H, Harima M . Effect of pregnancy on lower limb lymphedema in patients treated with multisite lymphaticovenular anastomoses (MLVAS). Lymphology. 2020; 52(4):187-193. View

Hayashi A, Hayashi N, Yoshimatsu H, Yamamoto T . Effective and efficient lymphaticovenular anastomosis using preoperative ultrasound detection technique of lymphatic vessels in lower extremity lymphedema. J Surg Oncol. 2017; 117(2):290-298. DOI: 10.1002/jso.24812. View

Akita S, Mitsukawa N, Kuriyama M, Kubota Y, Hasegawa M, Tokumoto H . Comparison of vascularized supraclavicular lymph node transfer and lymphaticovenular anastomosis for advanced stage lower extremity lymphedema. Ann Plast Surg. 2015; 74(5):573-9. DOI: 10.1097/SAP.0000000000000513. View

10.

Yoshida S, Koshima I, Sasaki A, Fujioka Y, Nagamatsu S, Yokota K . Mechanical Dilation Using Nylon Monofilament Aids Multisite Lymphaticovenous Anastomosis Through Improving the Quality of Anastomosis. Ann Plast Surg. 2018; 82(2):201-206. DOI: 10.1097/SAP.0000000000001681. View

11.

Campisi C, Boccardo F . Lymphedema and microsurgery. Microsurgery. 2002; 22(2):74-80. DOI: 10.1002/micr.21728. View

12.

Chung J, Baek S, Park H, Lee B, Park S, Yoon E . Efficacy and patient satisfaction regarding lymphovenous bypass with sleeve-in anastomosis for extremity lymphedema. Arch Plast Surg. 2019; 46(1):46-56. PMC: 6369058. DOI: 10.5999/aps.2018.00773. View

13.

Qiu S, Pruimboom T, Cornelissen A, Schols R, van Kuijk S, van der Hulst R . Outcomes following lymphaticovenous anastomosis (LVA) for 100 cases of lymphedema: results over 24-months follow-up. Breast Cancer Res Treat. 2020; 184(1):173-183. PMC: 7568701. DOI: 10.1007/s10549-020-05839-4. View

14.

Koshima I, Kawada S, Moriguchi T, Kajiwara Y . Ultrastructural observations of lymphatic vessels in lymphedema in human extremities. Plast Reconstr Surg. 1996; 97(2):397-405; discussion 406-7. DOI: 10.1097/00006534-199602000-00018. View

15.

Yoshida S, Koshima I, Imai H, Uchiki T, Sasaki A, Fujioka Y . Lymphovenous Anastomosis for Morbidly Obese Patients with Lymphedema. Plast Reconstr Surg Glob Open. 2020; 8(5):e2860. PMC: 7572113. DOI: 10.1097/GOX.0000000000002860. View

16.

Cormier J, Rourke L, Crosby M, Chang D, Armer J . The surgical treatment of lymphedema: a systematic review of the contemporary literature (2004-2010). Ann Surg Oncol. 2011; 19(2):642-51. DOI: 10.1245/s10434-011-2017-4. View

17.

Seki Y, Yamamoto T, Yoshimatsu H, Hayashi A, Kurazono A, Mori M . The Superior-Edge-of-the-Knee Incision Method in Lymphaticovenular Anastomosis for Lower Extremity Lymphedema. Plast Reconstr Surg. 2015; 136(5):665e-675e. DOI: 10.1097/PRS.0000000000001715. View

18.

Yamamoto T, Yoshimatsu H, Narushima M, Yamamoto N, Shim T, Seki Y . Sequential anastomosis for lymphatic supermicrosurgery: multiple lymphaticovenular anastomoses on 1 venule. Ann Plast Surg. 2012; 73(1):46-9. DOI: 10.1097/SAP.0b013e31826caff1. View

19.

Koshima I, Nanba Y, Tsutsui T, Takahashi Y, Itoh S, Fujitsu M . Minimal invasive lymphaticovenular anastomosis under local anesthesia for leg lymphedema: is it effective for stage III and IV?. Ann Plast Surg. 2004; 53(3):261-6. DOI: 10.1097/01.sap.0000120319.89926.07. View

20.

Mihara M, Hayashi Y, Murai N, Moriguchi H, Iida T, Hara H . Regional diagnosis of lymphoedema and selection of sites for lymphaticovenular anastomosis using elastography. Clin Radiol. 2011; 66(8):715-9. DOI: 10.1016/j.crad.2011.03.004. View