D40. Effects of Lymphaticovenular Anastomosis in Contralateral Leg in Patients with Acquired Bilateral Leg Lymphedema

Abstract

PURPOSE: Lymphaticovenular anastomosis (LVA) is an established treatment for fluid-predominant lymphedema. Its mechanism of action is believed to be mechanical decompression and therefore its benefits limited to where it is established. When LVA is performed in one leg in bilateral leg lymphedema, improvement is conventionally expected only in the treated leg and not in the contralateral leg. We aimed to investigate this widely accepted hypothesis. METHODS: All patients with acquired bilateral leg lymphedema who underwent LVA in one leg between February 2020 and March 2022 were included. Baseline and postoperative outcomes (at 3, 6, 12 months, and annually) were assessed by relief of symptoms, clinical examination, and indocyanine green (ICG) lymphography. RESULTS: Ten patients (7 females,3 males) met the inclusion criteria. All sustained lymphatic injury secondary to lymphadenectomy and/or radiation for cancer treatment. Five patients (50%) were symptomatic in bilateral legs while all ten had ICG lymphography confirmed lymphatic dysfunction in both legs. LVA was successfully performed in all cases. Mean follow-up was 11.3 months. Following LVA, relief of symptoms and improved functions were reported by all patients and confirmed on examination in all symptomatic limbs, with correlating improvements on ICG lymphography. Favorable ICG lymphography changes were also seen in the contralateral leg in all (5/5) who had asymptomatic contralateral leg lymphedema. CONCLUSION: The benefit of LVA extends beyond the anatomic region in which it is established.