Systematic review of lymphovenous anastomosis (LVA) for the treatment of lymphedema
Mario F. Scaglioni, Duveken B. Y. Fontein , Michael Arvanitakis, Pietro Giovanoli. Microsurgery. 2017;1–7
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Systematic review of lymphovenous anastomosis (LVA) for the treatment of lymphedema
Mario F. Scaglioni, Duveken B. Y. Fontein , Michael Arvanitakis, Pietro Giovanoli. Microsurgery. 2017;1–7
Introduction: Lymphedema is a chronic condition caused by the obstruction or impairment of lymphatic fluid transport resulting in irreversible skin fibrosis. Besides conservative therapy, surgical techniques for lymphedema including liposuction, lymphatico-lymphatic bypass, lymphovenous anastomosis (LVA), and vascularized lymph node transfer (VLNT) are options with increasing popularity in the recent past. In our review, we investigated the efficacy of LVA for the treatment of lymphedema. Both objective and subjective outcomes of surgical treatment were evaluated.
Methods: Studies were identified through systematic review in PubMed database up to September 2016. Only original Articles which exclusively performed LVA for lymphedema treatment were included. Our primary endpoint was the objective of a subjective postoperative lymphedema reduction.
Results: A total of 293 titles were identified, out of which 18 studies including 939 patients were deemed eligible. The studies included in this review describe significant variations in surgical techniques, number of anastomoses and supplementary interventions. All studies reported objective reductions in circumference measurements. Subjective symptom relief was found in 50-100% of the patients as well as a reduction in the number of cellulitis episodes in all investigated cases.
Conclusion: Although the studies included in this review showed great heterogeneity, LVA surgery revealed both objective and subjective improvements in most patients.
Main findings
- All studies demonstrated objective improvements in lymphedema measurements in the majority of included patients. LVA with or without compressive treatment also resulted in overall subjective symptom improvement.
- Most studies didn’t have long enough follow up. Concerns have been raised that LVA may fail after two or three years due to venous reflux.
- This study revealed an improved postoperative extremity circumference in patients over 11 years of age, while lymphedema worsened in patients 11 years or younger.
- Separately assessing patients by lymphedema etiology may lead to more conclusive findings and hence, more solid treatment recommendations, as the pathophysiology and clinical presentation of various forms of lymphedema are clearly distinctive.
- Great variations among the different studies especially in the number of surgically performed anastomoses per patient.
- LVA surgery can be a valuable treatment option for patients suffering from recurrent cellulitis as a result of lymphedema.
- This study was limited to a descriptive overview due to the available literature on the topic of LVA. An attempt to compare the different studies more closely was an unrealistic goal of this work, as the studies show a tremendous variety in several factors associated with LVA surgery.
- Studies require longer follow up.
