Outcomes following lymphaticovenous anastomosis (LVA) for 100 cases of lymphedema: results over 24-months follow-up

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CLINICAL TRIAL

Outcomes following lymphaticovenous anastomosis (LVA) for 100 cases of lymphedema: results over 24‑months follow‑up Shan S. Qiu1   · Tim Pruimboom1 · Anouk J. M. Cornelissen1 · Rutger M. Schols1 · Sander M. J. van Kuijk2 · René R. W. J. van der Hulst1 Received: 26 May 2020 / Accepted: 25 July 2020 © The Author(s) 2020

Abstract Purpose  Lymphedema is a debilitating condition that significantly affects patient’s quality of life (QoL). The aim of this study was to assess the long-term outcomes after lymphaticovenous anastomosis (LVA) for extremity lymphedema. Methods  A single-center prospective study on upper and lower extremity lymphedema patients was performed. All LVA procedures were preceded by outpatient Indocyanine Green (ICG) lymphography. Quality of life measured by the LymphICF was the primary outcome. Limb circumference, use of compression garments, and frequency of cellulitis episodes and manual lymphatic drainage (MLD) sessions were secondary outcomes. Results  One hundred consecutive patients, predominantly experiencing upper extremity lymphedema following breast cancer (n = 85), underwent a total of 132 LVAs. During a mean follow-up of 25 months, mean Lymph-ICF score significantly decreased from 43.9 preoperative to 30.6 postoperative, representing significant QoL improvement. Decrease in upper and lower limb circumference was observed in 52% of patients with a mean decrease of 6%. Overall mean circumference was not significantly different. Percentage of patients that could reduce compression garments in the upper and lower extremity group was 65% and 40%, respectively. Number of cellulitis episodes per year and MLD sessions per week showed a mean decrease of respectively 0.6 and 0.8 in the upper extremity and 0.4 and 1.0 in the lower extremity group. Conclusions  LVA resulted in significant QoL improvement in upper and lower extremity lymphedema patients. Limb circumference did not significantly improve but good results concerning compression garments, cellulitis episodes, and MLD sessions were obtained. Additionally, a simple and patient-friendly method for outpatient ICG lymphography is presented. Keywords  Lymphedema · LVA · Quality of life · Lymph-ICF · Indocyanine green · ICG Abbreviations BMI Body mass index CI Confidence interval ICG Indocyanine green ISL International society of lymphology LEL-index Lower extremity lymphedema index LVA Lymphaticovenous anastomosis

* Shan S. Qiu [email protected] 1



Department of Plastic and Reconstructive Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands



Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands

2

Lymph-ICF Lymphedema functioning, disability and health questionnaire MLD Manual lymphatic drainage OR Odds ratio QoL Quality of life UEL-index Upper extremity lymphedema index VAS Visual analogue score

Introduction Lymphedema is a chronic, debilitating c