Lymphaticovenular anastomosis combined with iliac vein stenting for post-oncological lower extremity lymphedema complicated by iliac vein compression syndrome: a two-year retrospective study

Post-oncological lower extremity lymphedema (LEL) complicated by iliac vein compression syndrome (IVCS) involves both lymphatic dysfunction and venous obstruction, and optimal management remains uncertain. We evaluated two-year outcomes of lymphaticovenular anastomosis (LVA) combined with iliac vein stenting. This retrospective single-center study included 122 patients treated with staged LVA, iliac vein stenting, and postoperative complex decongestive therapy between June 2018 and June 2023. Limb volume, Lymphedema Quality of Life Questionnaire (LYMQoL) scores, complications, and stent patency were assessed during 24 months of follow-up. Available-case generalized estimating equation (GEE) models evaluated longitudinal changes and exploratory time-by-covariate interactions. At 24 months, the GEE-derived EMM of affected-limb volume decreased from 10302.9 mL (SE 145.6; 95% CI 10017.5–10588.4) at baseline to 8247.9 mL (SE 115.0; 95% CI 8022.5–8473.3) at 24 months (mean difference − 2055.1 mL, 95% CI − 2193.9 to − 1916.2; P < 0.001), yielding a 19.8% reduction. The GEE-derived EMM of LYMQoL overall score increased from 4.1 ± 0.1 to 6.3 ± 0.1 (values are EMM ± SE; P < 0.001). Mixed-effects sensitivity analyses yielded similar longitudinal findings. Exploratory multivariable GEE analyses included 122 patients and 340 observations at 6, 12, and 24 months (n = 117, 114, and 109, respectively). BMI and lymphedema duration showed time-dependent associations with volume-reduction rate (time×BMI, P = 0.002; time×duration, P = 0.008), while preoperative LYMQoL overall score showed a time-dependent association with postoperative LYMQoL overall score (P = 0.034). At 24 months, cellulitis occurred in 9/109 (8.3%), wound-healing impairment in 2/109 (1.8%), and deep vein thrombosis in 4/109 (3.7%). Primary stent patency was 108/114 (94.7%) at 1 year and 100/109 (91.7%) at 2 years; secondary patency was 113/114 (99.1%) and 107/109 (98.2%), respectively. In this retrospective single-arm cohort, reductions in affected limb volume and improvements in quality-of-life scores were observed during 24 months of follow-up after staged lymphaticovenular anastomosis, iliac vein stenting, and postoperative complex decongestive therapy. Controlled prospective studies are required to determine the independent and comparative effects of each treatment component.