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. 2020 Nov;184(1):173-183.
doi: 10.1007/s10549-020-05839-4. Epub 2020 Aug 7.

Outcomes following lymphaticovenous anastomosis (LVA) for 100 cases of lymphedema: results over 24-months follow-up

Shan S Qiu  1 , Tim Pruimboom  2 , Anouk J M Cornelissen  2 , Rutger M Schols  2 , Sander M J van Kuijk  3 , René R W J van der Hulst  2
Affiliations

Outcomes following lymphaticovenous anastomosis (LVA) for 100 cases of lymphedema: results over 24-months follow-up

Shan S Qiu et al. Breast Cancer Res Treat. 2020 Nov.

Abstract

Purpose: Lymphedema is a debilitating condition that significantly affects patient's quality of life (QoL). The aim of this study was to assess the long-term outcomes after lymphaticovenous anastomosis (LVA) for extremity lymphedema.

Methods: A single-center prospective study on upper and lower extremity lymphedema patients was performed. All LVA procedures were preceded by outpatient Indocyanine Green (ICG) lymphography. Quality of life measured by the Lymph-ICF was the primary outcome. Limb circumference, use of compression garments, and frequency of cellulitis episodes and manual lymphatic drainage (MLD) sessions were secondary outcomes.

Results: One hundred consecutive patients, predominantly experiencing upper extremity lymphedema following breast cancer (n = 85), underwent a total of 132 LVAs. During a mean follow-up of 25 months, mean Lymph-ICF score significantly decreased from 43.9 preoperative to 30.6 postoperative, representing significant QoL improvement. Decrease in upper and lower limb circumference was observed in 52% of patients with a mean decrease of 6%. Overall mean circumference was not significantly different. Percentage of patients that could reduce compression garments in the upper and lower extremity group was 65% and 40%, respectively. Number of cellulitis episodes per year and MLD sessions per week showed a mean decrease of respectively 0.6 and 0.8 in the upper extremity and 0.4 and 1.0 in the lower extremity group.

Conclusions: LVA resulted in significant QoL improvement in upper and lower extremity lymphedema patients. Limb circumference did not significantly improve but good results concerning compression garments, cellulitis episodes, and MLD sessions were obtained. Additionally, a simple and patient-friendly method for outpatient ICG lymphography is presented.

Keywords: ICG; Indocyanine green; LVA; Lymph-ICF; Lymphedema; Quality of life.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Outpatient ICG lymphography. Preoperative planning using ICG lymphography in the outpatient clinic (a) Lymph vessels visualized by ICG lymphography; linear pattern to stardust pattern and (b) corresponding markings for incision site, based on ICG lymphography
Fig. 2
Fig. 2
Intraoperative picture of an end-to-end lymphaticovenous anastomosis
Fig. 3
Fig. 3
Mean Lymph-ICF preoperatively and postoperatively. Final Lymph-ICF measurement at last outpatient appointment for each patient (n = 100) over a mean follow-up 24.5 ± 10.9 months. Analysis: Paired Samples T-Test. *Statistically significant difference: A decrease of 10, 15, 12, 23, 15, and 14 in total score, physical function, mental function, household activities, mobility activities, and life and social activities were considered a statistically significant difference (p < 0.05) [29]
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