SP50. Can LVA Still Be Successfully Performed in Advanced Fluid-predominant Lymphedema?

Abstract

PURPOSE: Historically, supermicrosurgical lymphaticovenular anastomosis (LVA) is regarded technically difficult/unachievable and therefore contraindicated in advanced lymphedema demonstrating “diffuse” pattern and/or absence of “linear” pattern on indocyanine green (ICG) lymphography. More invasive vascularized lymph node transplants are preferred in these cases. In this study, we describe our experience of attempting LVA in these challenging cases. METHODS: All patients with fluid-predominant lymphedema who underwent LVA between February 2020 and March 2022 were included. Patients with pre-operative ICG lymphography demonstrating “diffuse” pattern and/or absence of “linear” pattern were included in the study group, while the remainder of LVA patients were assigned to the control group. Surgical time, number of LVAs, patient report, physical examination, and post-operative ICG lymphography at 3, 6, and 12 months were compared between study and control groups. RESULTS: Thirteen limbs showed “diffuse” pattern and/or absent “linear” pattern while 70 limbs showed “linear” pattern on pre-operative immediate ICG scan. Mean follow-up time was 14.18 ± 6.46 months and 14.83 ± 9.12 months for study and control groups, respectively. Surgical times (p=0.31) and number of LVAs (0.25) did not vary significantly between groups. Patient-reported symptom relief and reduction in swelling were seen in 11 limbs in the study group and 65 limbs in the control group (p=0.19). Post-operative ICG scans improved in 11 limbs in the study group and 68 limbs in the control group (p=0.22). No differences were identified in each comparison. CONCLUSION: LVA can be performed in advanced fluid-predominant lymphedema. The technical difficulty and efficacy of LVA in this group is not significantly different from patients with “linear” patterns on ICG lymphography.