Evaluation of patency rates of different lymphaticovenous anastomosis techniques and risk factors for obstruction in secondary upper extremity lymphedema.

OBJECTIVE: Lymphaticovenous anastomosis (LVA) is one of the surgical treatments for lymphedema. Lymphaticovenous side-to-end anastomosis (LVSEA) and lymphaticovenous end-to-end anastomosis (LVEEA) are the most commonly used procedures; however, only a few reports have evaluated direct anastomosis. We used indocyanine green fluorescence lymphography to evaluate and to compare both techniques.

METHODS: Eighteen patients (67 anastomoses) with secondary upper extremity lymphedema were evaluated 6 months postoperatively. After injection of indocyanine green, anastomoses that were obviously patent were considered patent, and the others were considered unpatent. In addition, we evaluated the risk factors for obstruction using the following five points: dyeing of the lymphatic vessel by patent blue, lymphatic flow, venous regurgitation, lymphatic vessel degeneration, and runoff after the anastomosis.

RESULTS: There were 44 LVSEAs and 23 LVEEAs performed, of which 14 (32%) and 8 (35%) were patent, respectively. Risk factors for obstruction in these 67 anastomoses were evaluated. However, no significant difference was found.

CONCLUSIONS: Patency of an LVA anastomosis is not high and not different between LVSEA and LVEEA. However, if anastomotic occlusion occurs, lymphatic obstruction is more likely with LVEEA than with LVSEA. Therefore, when LVA is performed, we recommend LVSEA principally and LVEEA only when the potential for consequences and risk of obstruction are low.