Lymphaticovenous Anastomosis Releases the Lower Extremity Lymphedema-associated Pain

Abstract

Background: We investigate the effectiveness of lymphaticovenous anastomosis (LVA) in releasing lymphedema-associated pain.

Methods: We performed a retrospective analysis. Subjects of this study included lower extremity lymphedema patients who presented persistent and constant degrees of pain in their lower limbs. LVA was performed under local anesthesia. The preoperative lower extremity pain and postoperative lower extremity pain were surveyed using the visual analog scale on a score from 0 to 10. The circumferences of the limbs were also recorded.

Results: A total of 8 patients (16 lower limbs) were included. The subjects included 1 man and 7 women, and their average age was 72 years. The average follow-up period was 17 months. The average preoperative and postoperative visual analog scale scores were 5.3 and 1.8, respectively. Moreover, 7 patients who had records of their lower extremity circumference observed an average changing rate of -4.7% in lower extremity lymphedema index after the surgery.

Conclusion: LVA can release the pain in the affected limbs of lymphedema.

Fig. 1.

The relationship between the difference of preoperative and postoperative VAS scores and the changing rate of preoperative and postoperative LEL indices. The vertical scale indicates the changing rate of LEL index and the horizontal scale indicates the difference in VAS scores.

Fig. 2.

The lymphoscintigraphy result of case 3 30 minutes after the isotope injection. A, Preoperative lymphoscintigraphy results; lymph congestion and lymphatic vessel dilatation can be observed in the bilateral lower extremities. B, Preoperative ICG lymphography results. C, Postoperative lymphoscintigraphy results; improvement in both lymph congestion and vessel dilatation can be observed.

Fig. 3.

The LVA procedure of case 3. A, Preoperative markings and a view of the patient’s entire lower extremities. B, Intraoperative LVA observation near the interior region of the right thigh; dilatation of the collecting lymphatic vessels can be seen. Ly, collecting lymphatic vessels, ectasis type; Ve, vein.

Fig. 4.

The preoperative lymphoscintigraphy and ICG lymphography results of case 7. A, The lymphoscintigraphy result; the right limb appears normal, but the left limb presents dermal backflow centralized in areas below the knee. B, The ICG lymphography result; splash pattern can be seen near the interior of the thigh on the right limb; a mixture of diffuse and stardust patterns is observed on the entire left limb with a higher ratio of diffuse pattern in the crus and a higher ratio of splash pattern in the thigh area; the lower abdominal area shows a splash pattern.