Abstract
Background A 76-year-old woman presented with rheumatoid lymphedema (RL) distal to the left
elbow after 20 years of affliction with rheumatoid arthritis (RA). Although the RA
was controlled by medication, the patient could not receive full-scale compression
therapy for her edema with a medium-pressure compression sleeve (pressure: 20–25 mm
Hg) due to hand dysfunction caused by long-term RA.
Methods Lymphaticovenular anastomosis (LVA) was performed after compression therapy with
a low-pressure sleeve (14–18 mm Hg) proved ineffective for edema relief. Two anastomoses
were created in a side-to-end fashion at the cubital fossa.
Results The edema improved rapidly after LVA and was maintained with a low-pressure compression
sleeve.
Conclusion LVA represents a treatment option for remaining RL in RA treatment. As some RL patients
are ineligible for full-scale compression therapy due to hand dysfunction caused by
RA, LVA may help to reduce RL and enable edema management using a low-pressure compression
garment without concern for hand dysfunction.
Keywords
rheumatoid arthritis - lymphedema - lymphaticovenular anastomosis
