A Single-Site Technique of Multiple Lymphatic-Venous Anastomoses for the Treatment of Peripheral Lymphedema: Long-Term Clinical Outcome.

Abstract

The authors' vast surgical experience in the treatment of primary and secondary peripheral lymphedemas using microsurgical procedures at the Centre of Lymphatic Surgery and Microsurgery of the University of Genoa, Italy, is reported. The objective is to describe the techniques and the long-lasting clinical outcomes based on 40 years' experience and research, with particular reference to advanced derivative and reconstructive lymphatic microsurgery at a single site. More than 2,600 patients affected by upper and/or lower limb lymphedema, between 1973 and 2013, underwent lymphatic microsurgery. Derivative multiple lymphatic-venous anastomoses (MLVA) or lymphatic pathway reconstruction using interpositioned vein-grafted shunts multiple lymphatic venous lymphatic anastomoses (MLVLA) were performed at a single site, either the axillary or inguinal-crural region. Patients were followed up for a minimum of 5 years to over 20 years. Clinical outcomes included excess limb volume (ELV), frequency of dermatolymphangioadenitis (DLA) attacks, and use of conservative therapies. Compared with preoperative conditions, patients obtained significant reductions in ELV of over 84%, with an average follow-up of 10 years or more. Over 86% of patients with earlier stages of disease (stage IB or IIA) progressively stopped using conservative therapies and 42% of patients with later stages (stages IIB and III) decreased the frequency of physical therapies. DLA attacks considerably reduced by over 91%. MLVA or MLVLA techniques when performed at a single site produce excellent outcomes in the treatment of both primary and secondary lymphedemas, giving the possibility of a complete restoration of lymphatic flow in early stages of disease when tissue changes are minimal.