Lymphaticovenous Anastomosis for Age-Related Lymphedema.

Toshio Uchiki,Ayano Sasaki,Solji Roh,Hirofumi Imai,Isao Koshima,Shuhei Yoshida,Shogo Nagamatsu,Toshiro Mese

doi:10.3390/jcm10215129

Toshio Uchiki, Ayano Sasaki + Show 6 more

Open Access

https://doi.org/10.3390/jcm10215129

Copy DOI

Abstract

Introduction: Primary lymphedema is usually caused by intrinsic disruption or genetic damage to the lymphatics but may also be the result of age-related deterioration of the lymphatics. The aims of this study were to determine the characteristics of age-related lymphedema and to assess the effectiveness of lymphaticovenous anastomosis (LVA) in its treatment. Methods: Eighty-six patients with primary lymphedema affecting 150 lower limbs were divided into three groups according to whether the age of onset was younger than 35 years, 35–64 years, or 65 years or older. Indocyanine green (ICG) lymphography was performed, followed by LVA surgery. ICG lymphography images were visually classified according to whether the pattern was linear, low enhancement (LE), distal dermal backflow (dDB), or extended dermal backflow (eDB). The lower extremity lymphedema (LEL) index score was calculated before and after LVA. Lymphatic vessel diameter and detection rates were also recorded. Results: In the ≥65 group, the lymphedema was bilateral in 54 patients and unilateral in 1 patient. There was statistically significant deterioration in the LEL index score with progression from the linear, LE, dDB through to the eDB pattern in the ≥65 group. The lymphatic vessel diameter was significantly greater in the ≥65 group. The rate of improvement was highest in the ≥65 group. Conclusion: Age-related lymphedema was bilateral and deterioration started distally. The lymphatic vessels in patients with age-related lymphedema tended to be ectatic, which is advantageous for LVA and may increase the improvement rate.

Highlights

Primary lymphedema with onset after 35 years of age is known as lymphedema tarda and is generally caused by intrinsic disruption or genetic damage in the lymphatic drainage system
The exclusion criteria were need for support/auxiliary aids for ambulation; body mass index (BMI) ≥ 35; edema controllable by conventional compression therapy using elastic stockings; history of a major invasive procedure to treat pelvic cancer including uterine cancer, prostate cancer, rectal cancer, metastatic cancer, and inguinal lymphadenectomy, radiation therapy to the lower limbs or abdomen, chronic cardiac failure, chronic kidney failure, hepatic cirrhosis, hypoproteinemia, deep venous thrombosis, phlebostasis or venous reflux, thyroid disorder, edema caused by other endocrine disorder, drug-related edema, or arteriovenous malformation
The patient lay in the supine position and repeated plantar flexion and dorsiflexion movements of the ankles and toes to reduce the delay in flow that often occurs during passage across the ankle joints and affects the Indocyanine green (ICG) lymphography images acquired [11]

Summary

Introduction

Primary lymphedema with onset after 35 years of age is known as lymphedema tarda and is generally caused by intrinsic disruption or genetic damage in the lymphatic drainage system. Some evidence suggests that lymphedema could be caused by an age-related decline in lymphatic pump function [1,2,3,4,5]. The characteristics of age-related lymphedema are not well understood and no treatment guidelines for this condition have been established. The aims of this study were threefold: to determine whether aging could be a cause of lymphedema in patients with onset after age 65 years, which is defined as “elderly”. By the World Health Organization [6]; to clarify its characteristics of these patients; and to assess the effectiveness of the widely used surgical method of lymphaticovenous anastomosis (LVA) [7,8,9] in these patients.

Objectives

Methods

Results

Conclusion