Reply: Changing the Paradigm: Lymphovenous Anastomosis in Advanced Stage Lower Extremity Lymphedema

Abstract Background We investigated whether preoperative lymphoscintigraphy could predict the treatment response of unilateral lymphovenous anastomosis (LVA) in patients with lower extremity lymphedema. Materials and methods A total of 17 patients undergoing lymphoscintigraphy subsequent to LVA was included. As qualitative lymphoscintigraphic indicators, ilioinguinal lymph node uptake, main lymphatic vessel, collateral vessel, and dermal backflow pattern were evaluated. Lymph node uptake ratio, extremity uptake ratio, and injection site clearance ratio were obtained as quantitative lymphoscintigraphic indicators at 1 and 2-h after injection. To evaluate therapy response, the volume difference ratio of the whole leg at 3 months (early response) and 1 year (late response) was measured. Results The group with whole leg dermal backflow had a greater volume change than the other groups (p=0.047). The group with dermal backflow in the whole leg OR only in the distal part had a higher rate of volume reduction than the group with dermal backflow only in the proximal part OR absent (p=0.050). The 2-h extremity uptake ratio was the only indicator that positively correlated with early and late volume difference ratio (p=0.016, p=0.001). The rate of volume decrease at 1 year was high in patients with high 2-h extremity uptake ratio (p=0.027). As the amount of dermal backflow increases, the postoperative therapeutic effect increases (p=0.040). Conclusions Preoperative lymphoscintigraphy is useful to predict both early and late therapy response in patients with lower extremity lymphedema undergoing LVA. Both dermal backflow pattern and extremity uptake ratio may be predictive lymphoscintigraphic indicators.

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Lymphovenous anastomosis: A reasonable treatment of secondary lower extremity lymphedema arising from the treatment of gynecologic malignancies

Gynecologic Oncology ◽

10.1016/j.ygyno.2019.04.388 ◽

2019 ◽

Vol 154 ◽

pp. 165-166

Author(s):

M.J. Song ◽

E.Y. Ki ◽

S.J. Lee

Keyword(s):

Lower Extremity ◽

Gynecologic Malignancies ◽

Lymphovenous Anastomosis

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Successful Treatment With Lymphovenous Anastomosis for Lower Extremity Edema Secondary to Lipiodol Lymphangiography

Journal of Clinical Case Reports ◽

10.4172/2165-7920.1000925 ◽

2017 ◽

Vol 07 (02) ◽

Author(s):

Shoichi Sasaki ◽

Yasutoshi Suzuki ◽

Kohei Umekawa ◽

Takashi Kurabayashi ◽

Hirotaka Asato

Keyword(s):

Lower Extremity ◽

Successful Treatment ◽

Lower Extremity Edema ◽

Lymphovenous Anastomosis

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Successful treatment of early-stage lower extremity lymphedema with side-to-end lymphovenous anastomosis with indocyanine green lymphography assisted

Microsurgery ◽

10.1002/micr.30010 ◽

2015 ◽

Vol 36 (4) ◽

pp. 310-315 ◽

Cited By ~ 22

Author(s):

Ran Ito ◽

Chieh-Tsai Wu ◽

Miffy Chia-Yu Lin ◽

Ming-Huei Cheng

Keyword(s):

Lower Extremity ◽

Indocyanine Green ◽

Successful Treatment ◽

Early Stage ◽

Lymphovenous Anastomosis

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Simultaneous Supraclavicular Lymph Node Transfer and Lymphovenous Anastomosis for the Surgical Treatment of End-Stage Lymphedema

10.21203/rs.3.rs-278654/v1 ◽

2021 ◽

Author(s):

Kyung-Chul Moon ◽

In-Jae Yoon

Keyword(s):

Lymph Node ◽

Lower Extremity ◽

Nonsurgical Management ◽

Inguinal Area ◽

History Of ◽

Lymph Node Transfer ◽

Lymphovenous Anastomosis ◽

The Right ◽

End Stage ◽

Vascularized Lymph Node Transfer

Abstract BackgroundVarious surgical options are available to treat lymphedema, such as direct excisional debulking surgery, suction-assisted lipectomy debulking, lymphovenous anastomosis (LVA), and vascularized lymph node transplantation (VLNT). However, no studies have addressed simultaneous surgery with both LVA and VLNT for patients with advanced-stage lymphedema. Case Presentation A 72-year-old female with bilateral lower extremity lymphedema refractory to nonsurgical management was admitted to our lymphedema clinic. This patient had a history of lymphoma and treated with radiotherapy on right inguinal area 26 years ago. Interestingly, the patient developed lymphedema on both the right and left lower extremities although she had radiotherapy on her right inguinal area. The patient underwent simultaneous vascularized lymph node transfer and lymphovenous anastomosis for treatment of end-stage lymphedema. Significant reduction in circumference and volume of lower extremity was achieved following simultaneous vascularized lymph node transfer and lymphonvenous anastomosis Conclusion The authors recommend simultaneous VLNT and LVA surgeries as the first treatment option for patients with end-stage lymphedema.

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Predictive role of lymphoscintigraphy undergoing lymphovenous anastomosis in patients with lower extremity lymphedema: a preliminary study

BMC Medical Imaging ◽

10.1186/s12880-021-00713-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hye Ryeong Kwon ◽

Ji Hye Hwang ◽

Goo-Hyun Mun ◽

Seung Hyup Hyun ◽

Seung Hwan Moon ◽

...

Keyword(s):

Lymph Node ◽

Lower Extremity ◽

Lower Limb ◽

Therapy Response ◽

Continuous Variable ◽

Late Response ◽

Uptake Ratio ◽

Clearance Ratio ◽

Lymphovenous Anastomosis ◽

Volume Difference

Abstract Background We investigated whether preoperative lymphoscintigraphy could predict the treatment response of unilateral lymphovenous anastomosis (LVA) in patients with lower extremity lymphedema. Materials and methods A total of 17 patients undergoing lymphoscintigraphy subsequent to LVA was included. As qualitative lymphoscintigraphic indicators, ilioinguinal lymph node uptake, main lymphatic vessel, collateral vessel, and four types of dermal backflow patterns (absent; distal only; proximal only; whole lower limb) were evaluated. Lymph node uptake ratio, extremity uptake ratio, and injection site clearance ratio were obtained as quantitative lymphoscintigraphic indicators at 1 and 2-h after injection. To evaluate therapy response, the volume difference ratio of the whole lower limb at 3 months (early response) and 1 year (late response) was measured. Volume difference ratios (continuous variable and binary variable with a cut-off value of zero) were compared according to the lymphoscintigraphic variables. Results The group with whole lower limb dermal backflow had a greater volume change than the other groups (p = 0.047). The group with dermal backflow in the whole lower limb OR only in the distal part had a higher rate of volume reduction than the group with dermal backflow only in the proximal part OR absent (p = 0.050). The 2-h extremity uptake ratio was the only indicator that positively correlated with early and late volume difference ratio (p = 0.016, p = 0.001). The rate of volume decrease at 1 year was high in patients with high 2-h extremity uptake ratio (p = 0.027). As the amount of dermal backflow increases, the postoperative therapeutic effect increases (p = 0.040). Conclusions Preoperative lymphoscintigraphy is useful to predict both early and late therapy response in patients with lower extremity lymphedema undergoing LVA. Both dermal backflow pattern and extremity uptake ratio may be predictive lymphoscintigraphic indicators.

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