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Can LVA still be successfully performed in advanced fluid-predominant lymphedema?
Lianne Mulvihill, BA, Ying Ku, BS, Sonia Pandey, MD, Brian Figueroa, MD, Mazen Al-Malak, MD, Jacob Lammers, DO, Diane Jo, MA, Wei F Chen, MD, FACS
Cleveland Clinic, Department of Plastic and Reconstructive Surgery
2023-02-10
Presenter: Lianne Mulvihill
Affidavit:
I agree with the breakdown of work listed below for Lianne Mulvihill.
Director Name: Steven Bernard
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: General Reconstruction
Introduction: Supermicrosurgical lymphaticovenular anastomosis (LVA) is regarded technically difficult/unachievable and therefore contraindicated in advanced lymphedema demonstrating "diffuse" 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" 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 scans at 3, 6, and 12 months were compared between both groups.
Results: Thirteen limbs showed "diffuse" 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 (p=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).
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.
