Serial two-year follow-up after lymphaticovenular anastomosis for the treatment of lymphedema

Purpose: Despite extensive previous investigations regarding the efficacy of lymphaticovenular anastomosis (LVA) for the treatment of lymphedema, few studies have reported the long-term clinical course of individual patients undergoing LVA. The present study presented our experience of LVA and to report serial postoperative courses. Methods: A retrospective chart review was performed for 17 patients (2 male and 15 female) with lymphedema refractory to conservative treatment who underwent LVA and were followed-up for at least postoperative 24 months. Mean age was 39 years. There were 7 cases with primary lymphedema and 10 with secondary lymphedema. Three patients had lymphedema in upper extremity and the other 14 had lesions in lower extremity. Outcomes were evaluated via qualitative assessment and quantitative volume measurement conducted preoperatively and 6, 12, and 24 months postoperatively. Results: LVA was performed in the distal extremities with a mean number of 2.5 (1–3). No postoperative complications developed. Average follow-up period was 41.8 months. Of 17 patients, 10 showed improvement in excess volume consistently during the follow-up period, whereas 3 patients exhibited temporary improvement at postoperative 6 months and subsequent aggravation at the latter follow-ups. No improvement was observed throughout the follow-up period in 4 patients. The requirements of complex decongestive physical therapy significantly decreased from 1.7 to 0.77 per patient per year. The frequency of cellulitis also decreased from 0.31 to 0.16 per patient per year. Conclusion: Our results suggest that LVA may have long-term effectiveness and provide a favorable clinical course in the long term.