Surgical outcomes of lymphaticovenous anastomosis in lower limb lymphedema: A single center 12 years’ experience

Background: Lower limb lymphedema is a chronic, debilitating condition characterised by abnormal fluid collection in interstitial space due to compromised lymphatic drainage, resulting in disfiguring swelling and skin alterations. Lymphaticovenous anastomosis (LVA) is a minimally invasive procedure that connects superficial lymphatic vessels to adjacent veins, establishing lymphatic-venous pathways. The aim of this study was to assess its surgical effectiveness in managing lower extremity lymphedema.Methods: We hereby report a single-centre retrospective study involving 9 patients who underwent LVA procedures between December 2012[1] and February 2024, with post-operative follow-up period of at least 6 months. The inclusion criteria were patients who had undergone a LVA procedure and had at least 6 months of post-operative follow-up. The exclusion criteria included patients diagnosed with upper limb lymphedema, those who had other lymphedema surgeries on the same limb, or those with incomplete pre- and post-operative limb measurement data. Surgical outcomes were evaluated by calculating limb volume through limb circumference measurements.Results: Over half of the group (N=6 [66.7%]) were diagnosed with unilateral lymphedema, and the remaining individuals (N=3 [33.3%]) had bilateral symptoms. Lymphedema severity was at stage 2a in four patients (44.5%), stage 2b in three patients (33.3%), and stage 3 in two patients (22.2%). Secondary lymphedema (N=6 [66.7%]) is more prevalent than primary lymphedema (N=3 [33.3%]), of which most notable secondary causes being Filariasis (N=3 [50%]), followed by trauma (N=2 [33.3%]), and malignancy (N=1 [16.7%]). The mean pre- and post-operative limb circumference (measurement of every 10th cm) were 266.06±40.22cm (95% CI 235.14-296.97) and 260.17±43.14cm (95% CI 227.01-293.33), respectively. The volume reduction was observed in 8 limbs (88.9%) out of 9 limbs, and the mean volume change was -0.0396±0.1479% which was insignificantly different (t8=0.816, P=0.438).Conclusion: LVA effectively reduced limb circumference in carefully selected patients. Further research with a larger study population is necessary to ascertain whether patient characteristics correlate significantly with successful LVA surgery.