Comparison of patency rates of lymphaticovenous anastomoses at different sites for lower extremity lymphedema.

OBJECTIVE: Lymphaticovenous anastomosis (LVA) is one of the surgical treatments of lymphedema. However, only a few reports have evaluated LVA directly. This study aimed to evaluate the patency of LVA using indocyanine green fluorescence lymphography and to determine the optimal anastomosis site in patients with lower extremity lymphedema.

METHODS: Thirty-six patients, with a total of 123 anastomoses for lower extremity lymphedema including 3 cases of idiopathic lymphedema, who underwent LVA for the first time between March 2014 and March 2017 were selected for enrollment in this study. The patency of the anastomoses was evaluated using PDE-neo (Hamamatsu Photonics, Hamakita, Japan) by injecting indocyanine green into the subcutaneous tissue at 6 months postoperatively. The site of anastomosis was the intersection point of the lymphatic vessel and vein, which was identified preoperatively. To determine the best surgical location, the anastomosis site was classified into the joint area (ankle and knee) and nonjoint area (dorsum and lower leg). The anastomosis was evaluated as either patent or nonpatent.

RESULTS: Patency was confirmed in 37 of the 76 (49%) anastomoses at the joint area and 12 of the 47 (26%) at nonjoint areas (P = .01).

CONCLUSIONS: The patency rate was significantly higher around the joint area than at the nonjoint areas. LVA around the joint area is recommended to ensure favorable technical and surgical outcomes for patients with lower extremity lymphedema.