Arch Hand Microsurg.  2018 Jun;23(2):116-120. 10.12790/ahm.2018.23.2.116.

Lymphaticovenous Anastomosis in Lower Extremity Lymphedema: A Case Report

• Lee SH

• KMID: 2412481
• DOI: http://doi.org/10.12790/ahm.2018.23.2.116

Abstract

Treatment of secondary lymphedema at the lower extremities is largely divided into two methods: removal of lymphatic tissue and bypass of lymphatic perfusion. We report a case of lymphaticovenous anastomosis in a patient with secondary lower extremity lymphedema. A 59-year-old woman underwent lymphaticovenous anastomosis in inguinal, knee, and ankle due to obstructive lymphedema in the left lower extremity after performed radical cuff resection, Bilateral Pelvic Lymphadenectomy, Periarterial Lymphadenectomy, and total omentectomy for ovarian cancer and metastatic carcinoma. At 1 year follow-up, there was a decrease of 32.8% in volume differential compared to the preoperative level. Understanding of the features of lymphaticovenous anastomosis, we can expect good results in secondary obstructive lymphedema patients.

Keyword

Lymphaticovenous anastomosis; Lymphedema; Lower extremity

MeSH Terms

Ankle
Female
Follow-Up Studies
Humans
Knee
Lower Extremity*
Lymph Node Excision
Lymphedema*
Lymphoid Tissue
Middle Aged
Ovarian Neoplasms
Perfusion

Figure

• 

  Fig. 1 (A) Photo of the 59-year-old female patient before surgery showing the symptom of secondary obstructive lymphedema at her left lower extremity. Her left leg is 50.7% larger than her right leg. (B) The lymphoscintigraphy scan showing the dermal backflow at the left lower extremity but not the inguinal lymph node activity. (C) Computed tomography scan showing the symptom of subcutaneous edema at lower left extremity and fluid collection at the deep fascia. (D) Photo during the surgery of end-to-side anastomosis between lymph vessel and superficial vein at two parts of the ankle (a), each one part of the knee joint and inguinal part (b, c). (E) Lymphaticovenous anastomosis was performed in this patient. At 6 months and 1 year, the patient's left leg was 43.3% and 13.5% larger than her right leg, respectively (a 32.8% reduction in volume differential) and wrinkles appeared around the knee joint due to the decrease of swelling. OP: operation, POD: postoperative day.

Reference

1. Yamamoto T, Yoshimatsu H, Narushima M, et al. A modified side-to-end lymphaticovenular anastomosis. Microsurgery. 2013; 33:130–133.

2. Koshima I, Inagawa K, Urushibara K, Moriguchi T. Supermicrosurgical lymphaticovenular anastomosis for the treatment of lymphedema in the upper extremities. J Reconstr Microsurg. 2000; 16:437–442.

3. Ito R, Wu CT, Lin MC, Cheng MH. Successful treatment of early-stage lower extremity lymphedema with side-to-end lymphovenous anastomosis with indocyanine green lymphography assisted. Microsurgery. 2016; 36:310–315.

4. Tourani SS, Taylor GI, Ashton MW. Long-term patency of lymphovenous anastomoses: a systematic review. Plast Reconstr Surg. 2016; 138:492–498.

5. Liu HL, Pang SY, Chan YW. The use of a microscope with near-infrared imaging function in indocyanine green lymphography and lymphaticovenous anastomosis. J Plast Reconstr Aesthet Surg. 2014; 67:231–236.

6. Allen RJ Jr, Cheng MH. Lymphedema surgery: patient selection and an overview of surgical techniques. J Surg Oncol. 2016; 113:923–931.

7. Narushima M, Mihara M, Yamamoto Y, Iida T, Koshima I, Mundinger GS. The intravascular stenting method for treatment of extremity lymphedema with multiconfiguration lymphaticovenous anastomoses. Plast Reconstr Surg. 2010; 125:935–943.