Download PDF
CC BY-NC-ND 4.0 · Indian J Plast Surg 2020; 53(01): 017-024
DOI: 10.1055/s-0040-1709372
Systematic Review

Lymphaticovenous Anastomosis for Lower Extremity Lymphedema: A Systematic Review

Antonio J. Forte 
1   Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida, United States
,
Nawal Khan
2   Ziauddin Hospital, Karachi, Pakistan
,
Maria T. Huayllani
1   Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida, United States
,
Daniel Boczar
1   Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida, United States
,
Humza Y. Saleem
3   Department of Surgery, Mayo Clinic, Jacksonville, Florida, United States
,
Xiaona Lu
4   Division of Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, Connecticut, United States
,
Oscar J. Manrique
5   Division of Plastic Surgery, Mayo Clinic, Rochester, Minnesota, United States
,
Pedro Ciudad
6   Department of Plastic, Reconstructive and Burn Surgery, Arzobispo Loayza National Hospital, Lima, Peru
,
Sarah A. McLaughlin
3   Department of Surgery, Mayo Clinic, Jacksonville, Florida, United States
› Author Affiliations Funding This study was supported in part by the Mayo Clinic Center for Individualized Medicine and the Plastic Surgery Foundation.
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background Lymphedema is an accumulation of protein-rich fluid in the interstitial spaces resulting from impairment in the lymphatic circulation that can impair quality of life and cause considerable morbidity. Lower extremity lymphedema (LEL) has an overall incidence rate of 20%. Conservative therapies are the first step in treatment of LEL; however, they do not provide a cure because they fail to address the underlying physiologic dysfunction of the lymphatic system. Among several surgical alternatives, lymphaticovenous anastomosis (LVA) has gained popularity due to its improved outcomes and less invasive approach. This study aims to review the published literature on LVA for LEL treatment and to analyze the surgical outcomes.

Methods PubMed database was used to perform a comprehensive literature review of all articles describing LVA for treatment of LEL from Novemeber 1985 to June 2019. Search terms included “lymphovenous” OR “lymphaticovenous” AND “bypass” OR “anastomosis” OR “shunt” AND “lower extremity lymphedema.”

Results A total of 95 articles were identified in the initial query, out of which 58 individual articles were deemed eligible. The studies included in this review describe notable variations in surgical techniques, number of anastomoses, and supplementary interventions. All, except one study, reported positive outcomes based on limb circumference and volume changes or subjective clinical improvement. The largest reduction rate in limb circumference and volume was 63.8%.

Conclusion LVA demonstrated a considerable reduction in limb volume and improvement in subjective findings of lymphedema in the majority of patients. The maintained effectiveness of this treatment modality in long-term follow-up suggests great efficacy of LVA in LEL treatment.

Keywords

lower extremity - lymphaticovenous anastomosis - lymphaticovenous bypass - lymphedema - lymphovenous anastomosis - lymphovenous bypass

Supplementary Material



Publication History

Article published online:
17 April 2020

© .

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 

  • References

  • 1 Salgarello M, Mangialardi ML, Pino V, Gentileschi S, Visconti G. A prospective evaluation of health-related quality of life following lymphaticovenular anastomosis for upper and lower extremities lymphedema. J Reconstr Microsurg 2018; 34 (09) 701-707
    Article in Thieme ConnectPubMedGoogle Scholar
  • 2 Brorson H, Ohlin K, Olsson G, Nilsson M. Adipose tissue dominates chronic arm lymphedema following breast cancer: an analysis using volume rendered CT images. Lymphat Res Biol 2006; 4 (04) 199-210
    CrossrefPubMedGoogle Scholar
  • 3 Ruocco V, Schwartz RA, Ruocco E. Lymphedema: an immunologically vulnerable site for development of neoplasms. J Am Acad Dermatol 2002; 47 (01) 124-127
    CrossrefPubMedGoogle Scholar
  • 4 Becker C, Arrive L, Saaristo A. et al Surgical treatment of congenital lymphedema. Clin Plast Surg 2012; 39 (04) 377-384
    CrossrefPubMedGoogle Scholar
  • 5 Liu X, Pasula S, Song H. et al Temporal and spatial regulation of epsin abundance and VEGFR3 signaling are required for lymphatic valve formation and function. Sci Signal 2014; 7 (347) ra97
    CrossrefPubMedGoogle Scholar
  • 6 Rustgi AK, Rotolo FS, Peete WP, Vollmer RT, Meyers WC. Successful management of late-onset primary lymphatic hypoplasia. Surgery 1985; 97 (06) 714-720
    PubMedGoogle Scholar
  • 7 Hara H, Mihara M, Okuda I. et al Presence of thoracic duct abnormalities in patients with primary lymphoedema of the extremities. J Plast Reconstr Aesthet Surg 2012; 65 (11) e305-e310
    CrossrefPubMedGoogle Scholar
  • 8 Hara H, Koshima I, Okuda I, Narushima M, Mihara M, Todokoro T. Assessment of configuration of thoracic duct using magnetic resonance thoracic ductography in idiopathic lymphedema. Ann Plast Surg 2012; 68 (03) 300-302
    CrossrefPubMedGoogle Scholar
  • 9 Hara H, Mihara M, Seki Y, Koshima I. Lymphoedema caused by idiopathic lymphatic thrombus. J Plast Reconstr Aesthet Surg 2013; 66 (12) 1780-1783
    CrossrefPubMedGoogle Scholar
  • 10 Garfein ES, Borud LJ, Warren AG, Slavin SA. Learning from a lymphedema clinic: an algorithm for the management of localized swelling. Plast Reconstr Surg 2008; 121 (02) 521-528
    CrossrefPubMedGoogle Scholar
  • 11 Witte CL, Witte MH. Disorders of lymph flow. Acad Radiol 1995; 2 (04) 324-334
    CrossrefPubMedGoogle Scholar
  • 12 Olszewski W. On the pathomechanism of development of postsurgical lymphedema. Lymphology 1973; 6 (01) 35-51
    PubMedGoogle Scholar
  • 13 Forte AJ, Huayllani MT, Boczar D, Ciudad P, McLaughlin SA. Lipoaspiration for the treatment of lower limb lymphedema: a comprehensive systematic review. Cureus 2019; 11 (10) e5913
    PubMedGoogle Scholar
  • 14 Ki EY, Park JS, Lee KH, Hur SY. Incidence and risk factors of lower extremity lymphedema after gynecologic surgery in ovarian cancer. Int J Gynecol Cancer 2016; 26 (07) 1327-1332
    CrossrefPubMedGoogle Scholar
  • 15 Kim JH, Choi JH, Ki EY. et al Incidence and risk factors of lower-extremity lymphedema after radical surgery with or without adjuvant radiotherapy in patients with FIGO stage I to stage IIA cervical cancer. Int J Gynecol Cancer 2012; 22 (04) 686-691
    CrossrefPubMedGoogle Scholar
  • 16 Beesley VL, Rowlands IJ, Hayes SC. et al Australian National Endometrial Cancer Study Group. Incidence, risk factors and estimates of a woman’s risk of developing secondary lower limb lymphedema and lymphedema-specific supportive care needs in women treated for endometrial cancer. Gynecol Oncol 2015; 136 (01) 87-93
    CrossrefPubMedGoogle Scholar
  • 17 Cormier JN, Askew RL, Mungovan KS, Xing Y, Ross MI, Armer JM. Lymphedema beyond breast cancer: a systematic review and meta-analysis of cancer-related secondary lymphedema. Cancer 2010; 116 (22) 5138-5149
    CrossrefPubMedGoogle Scholar
  • 18 Huang J, Yu N, Wang X, Long X. Incidence of lower limb lymphedema after vulvar cancer: A systematic review and meta-analysis. Medicine (Baltimore) 2017; 96 (46) e8722
    Google Scholar
  • 19 Forte AJ, Huayllani MT, Boczar D, Cinotto G, McLaughlin SA. Ultrasound elastography use in lower extremity lymphedema: a systematic review of the literature. Cureus 2019; 11 (09) e5578
    PubMedGoogle Scholar
  • 20 Hareyama H, Hada K, Goto K. et al Prevalence, classification, and risk factors for postoperative lower extremity lymphedema in women with gynecologic malignancies: a retrospective study. Int J Gynecol Cancer 2015; 25 (04) 751-757
    CrossrefPubMedGoogle Scholar
  • 21 Yamamoto T, Yamamoto N, Fuse Y, Narushima M, Koshima I. Optimal sites for supermicrosurgical lymphaticovenular anastomosis: an analysis of lymphatic vessel detection rates on 840 surgical fields in lower extremity lymphedema patients. Plast Reconstr Surg 2018; 142 (06) 924e-930e
    CrossrefPubMedGoogle Scholar
  • 22 Visconti G, Salgarello M, Hayashi A. The recipient venule in supermicrosurgical lymphaticovenular anastomosis: flow dynamic classification and correlation with surgical outcomes. J Reconstr Microsurg 2018; 34 (08) 581-589
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 Scaglioni MF, Uyulmaz S. Lymphovenous anastomosis and debulking procedure for treatment of combined severe lower extremity and genital lymphedema: A case report. Microsurgery 2018; 38 (08) 907-911
    CrossrefPubMedGoogle Scholar
  • 24 Mihara M, Hara H, Tsubaki H. et al Combined conservative treatment and lymphatic venous anastomosis for severe lower limb lymphedema with recurrent cellulitis. Ann Vasc Surg 2015; 29 (06) 1318.e11-1318.e15
    CrossrefPubMedGoogle Scholar
  • 25 Mihara M, Zhou HP, Hara H, Tange S, Haragi M. Case report: a new hybrid surgical approach for treating mosaic pattern secondary lymphedema in the lower extremities. Ann Vasc Surg 2014; 28 (07) 1798.e1-1798.e6
    CrossrefPubMedGoogle Scholar
  • 26 Mihara M, Murai N, Hayashi Y. et al Popliteal lymphatico-venous anastomosis for lower limb lymphedema to allow patients to adopt the traditional Japanese “seiza” sitting position. J Plast Reconstr Aesthet Surg 2011; 64 (11) 1544-1546
    CrossrefPubMedGoogle Scholar
  • 27 Suehiro K, Morikage N, Murakami M, Yamashita O, Hamano K. Primary lymphedema complicated by weeping chylous vesicles in the leg and scrotum: report of a case. Surg Today 2012; 42 (11) 1100-1103
    CrossrefPubMedGoogle Scholar
  • 28 Olszewski WL. Lymphovenous microsurgical shunts in treatment of lymphedema of lower limbs: a 45-year experience of one surgeon/one center. Eur J Vasc Endovasc Surg 2013; 45 (03) 282-290
    CrossrefPubMedGoogle Scholar
  • 29 Pereira N, Lee YH, Suh Y. et al Cumulative experience in lymphovenous anastomosis for lymphedema treatment: the learning curve effect on the overall outcome. J Reconstr Microsurg 2018; 34 (09) 735-741
    Article in Thieme ConnectPubMedGoogle Scholar
  • 30 Mihara M, Hara H, Tange S. et al Multisite lymphaticovenular bypass using supermicrosurgery technique for lymphedema management in lower lymphedema cases. Plast Reconstr Surg 2016; 138 (01) 262-272
    CrossrefPubMedGoogle Scholar
  • 31 Auba C, Marre D, Rodríguez-Losada G, Hontanilla B. Lymphaticovenular anastomoses for lymphedema treatment: 18 months postoperative outcomes. Microsurgery 2012; 32 (04) 261-268
    CrossrefPubMedGoogle Scholar
  • 32 Campisi C, Davini D, Bellini C. et al Lymphatic microsurgery for the treatment of lymphedema. Microsurgery 2006; 26 (01) 65-69
    CrossrefPubMedGoogle Scholar
  • 33 Yamamoto T, Matsuda N, Doi K. et al The earliest finding of indocyanine green lymphography in asymptomatic limbs of lower extremity lymphedema patients secondary to cancer treatment: the modified dermal backflow stage and concept of subclinical lymphedema. Plast Reconstr Surg 2011; 128 (04) 314e-321e
    CrossrefPubMedGoogle Scholar
  • 34 Mihara M, Hara H, Kawakami Y. et al Multi-site lymphatic venous anastomosis using echography to detect suitable subcutaneous vein in severe lymphedema patients. J Plast Reconstr Aesthet Surg 2018; 71 (02) e1-e7
    CrossrefPubMedGoogle Scholar
  • 35 Akita S, Mitsukawa N, Kuriyama M. et al Comparison of vascularized supraclavicular lymph node transfer and lymphaticovenular anastomosis for advanced stage lower extremity lymphedema. Ann Plast Surg 2015; 74 (05) 573-579
    CrossrefPubMedGoogle Scholar
  • 36 Maegawa J, Hosono M, Tomoeda H, Tosaki A, Kobayashi S, Iwai T. Net effect of lymphaticovenous anastomosis on volume reduction of peripheral lymphoedema after complex decongestive physiotherapy. Eur J Vasc Endovasc Surg 2012; 43 (05) 602-608
    CrossrefPubMedGoogle Scholar
  • 37 Maegawa J, Mikami T, Yamamoto Y, Satake T, Kobayashi S. Types of lymphoscintigraphy and indications for lymphaticovenous anastomosis. Microsurgery 2010; 30 (06) 437-442
    CrossrefPubMedGoogle Scholar
  • 38 Ito R, Wu CT, Lin MC, Cheng MH. Successful treatment of early-stage lower extremity lymphedema with side-to-end lymphovenous anastomosis with indocyanine green lymphography assisted. Microsurgery 2016; 36 (04) 310-315
    CrossrefPubMedGoogle Scholar
  • 39 Patel KM, Lin CY, Cheng MH. A prospective evaluation of lymphedema-specific quality-of-life outcomes following vascularized lymph node transfer. Ann Surg Oncol 2015; 22 (07) 2424-2430
    CrossrefPubMedGoogle Scholar
  • 40 Committee E. Executive Committee. The diagnosis and treatment of peripheral lymphedema: 2016 consensus document of the International Society of Lymphology. Lymphology 2016; 49 (04) 170-184
    PubMedGoogle Scholar
  • 41 Gloviczki P, Hollier LH, Nora FE, Kaye MP. The natural history of microsurgical lymphovenous anastomoses: an experimental study. J Vasc Surg 1986; 4 (02) 148-156
    CrossrefPubMedGoogle Scholar
  • 42 Chen WF, Zhao H, Yamamoto T, Hara H, Ding J. Indocyanine Green Lymphographic Evidence of Surgical Efficacy Following Microsurgical and Supermicrosurgical Lymphedema Reconstructions. J Reconstr Microsurg 2016; 32 (09) 688-698
    Article in Thieme ConnectPubMedGoogle Scholar
  • 43 Akita S, Ogata F, Manabe I. et al Noninvasive screening test for detecting early stage lymphedema using follow-up computed tomography imaging after cancer treatment and results of treatment with lymphaticovenular anastomosis. Microsurgery 2017; 37 (08) 910-916
    CrossrefPubMedGoogle Scholar
  • 44 Yamamoto Y, Sugihara T. Microsurgical lymphaticovenous implantation for the treatment of chronic lymphedema. Plast Reconstr Surg 1998; 101 (01) 157-161
    CrossrefPubMedGoogle Scholar
  • 45 Chung JH, Baek SO, Park HJ, Lee BI, Park SH, Yoon ES. Efficacy and patient satisfaction regarding lymphovenous bypass with sleeve-in anastomosis for extremity lymphedema. Arch Plast Surg 2019; 46 (01) 46-56
    Article in Thieme ConnectPubMedGoogle Scholar
  • 46 Yamamoto T, Narushima M, Kikuchi K. et al Lambda-shaped anastomosis with intravascular stenting method for safe and effective lymphaticovenular anastomosis. Plast Reconstr Surg 2011; 127 (05) 1987-1992
    CrossrefPubMedGoogle Scholar
  • 47 Yamamoto T, Yoshimatsu H, Narushima M. et al Sequential anastomosis for lymphatic supermicrosurgery: multiple lymphaticovenular anastomoses on 1 venule. Ann Plast Surg 2014; 73 (01) 46-49
    CrossrefPubMedGoogle Scholar
  • 48 Yamamoto T, Kikuchi K, Yoshimatsu H, Koshima I. Ladder-shaped lymphaticovenular anastomosis using multiple side-to-side lymphatic anastomoses for a leg lymphedema patient. Microsurgery 2014; 34 (05) 404-408
    CrossrefPubMedGoogle Scholar
  • 49 Ayestaray B, Bekara F. π-shaped lymphaticovenular anastomosis: the venous flow sparing technique for the treatment of peripheral lymphedema. J Reconstr Microsurg 2014; 30 (08) 551-560
    Article in Thieme ConnectPubMedGoogle Scholar
  • 50 Chen WF, Yamamoto T, Fisher M, Liao J, Carr J. The “Octopus” Lymphaticovenular Anastomosis: Evolving Beyond the Standard Supermicrosurgical Technique. J Reconstr Microsurg 2015; 31 (06) 450-457
    Article in Thieme ConnectPubMedGoogle Scholar
  • 51 Yasunaga Y, Yanagisawa D, Ohata E, Matsuo K, Yuzuriha S. Bioelectrical Impedance Analysis of Water Reduction in Lower-Limb Lymphedema by Lymphaticovenular Anastomosis. J Reconstr Microsurg 2019; 35 (04) 306-314
    Article in Thieme ConnectPubMedGoogle Scholar
  • 52 Yamamoto T, Yoshimatsu H, Narushima M. et al A modified side-to-end lymphaticovenular anastomosis. Microsurgery 2013; 33 (02) 130-133
    CrossrefPubMedGoogle Scholar
  • 53 Koshima I, Nanba Y, Tsutsui T, Takahashi Y, Itoh S, Fujitsu M. Minimal invasive lymphaticovenular anastomosis under local anesthesia for leg lymphedema: is it effective for stage III and IV?. Ann Plast Surg 2004; 53 (03) 261-266
    CrossrefPubMedGoogle Scholar
  • 54 Yoshida S, Koshima I, Sasaki A. et al Mechanical dilation using nylon monofilament aids multisite lymphaticovenous anastomosis through improving the quality of anastomosis. Ann Plast Surg 2019; 82 (02) 201-206
    CrossrefPubMedGoogle Scholar
  • 55 Mihara M, Hayashi Y, Murai N. et al Regional diagnosis of lymphoedema and selection of sites for lymphaticovenular anastomosis using elastography. Clin Radiol 2011; 66 (08) 715-719
    CrossrefPubMedGoogle Scholar
  • 56 Mihara M, Hara H, Narushima M. et al Lower limb lymphedema treated with lymphatico-venous anastomosis based on pre- and intraoperative icg lymphography and non-contact vein visualization: A case report. Microsurgery 2012; 32 (03) 227-230
    CrossrefPubMedGoogle Scholar
  • 57 Hayashi A, Hayashi N, Yoshimatsu H, Yamamoto T. Effective and efficient lymphaticovenular anastomosis using preoperative ultrasound detection technique of lymphatic vessels in lower extremity lymphedema. J Surg Oncol 2018; 117 (02) 290-298
    CrossrefPubMedGoogle Scholar
  • 58 Hara H, Mihara M, Ohtsu H, Narushima M, Iida T, Koshima I. Indication of Lymphaticovenous Anastomosis for Lower Limb Primary Lymphedema. Plast Reconstr Surg 2015; 136 (04) 883-893
    CrossrefPubMedGoogle Scholar
  • 59 Chang DW, Suami H, Skoracki R. A prospective analysis of 100 consecutive lymphovenous bypass cases for treatment of extremity lymphedema. Plast Reconstr Surg 2013; 132 (05) 1305-1314
    CrossrefPubMedGoogle Scholar
  • 60 Demirtas Y, Ozturk N, Yapici O, Topalan M. Supermicrosurgical lymphaticovenular anastomosis and lymphaticovenous implantation for treatment of unilateral lower extremity lymphedema. Microsurgery 2009; 29 (08) 609-618
    CrossrefPubMedGoogle Scholar
  • 61 Matsubara S, Sakuda H, Nakaema M, Kuniyoshi Y. Long-term results of microscopic lymphatic vessel-isolated vein anastomosis for secondary lymphedema of the lower extremities. Surg Today 2006; 36 (10) 859-864
    CrossrefPubMedGoogle Scholar
  • 62 Koshima I, Nanba Y, Tsutsui T, Takahashi Y, Itoh S. Long-term follow-up after lymphaticovenular anastomosis for lymphedema in the leg. J Reconstr Microsurg 2003; 19 (04) 209-215
    Article in Thieme ConnectPubMedGoogle Scholar
  • 63 Lee KT, Park JW, Mun GH. Serial two-year follow-up after lymphaticovenular anastomosis for the treatment of lymphedema. Microsurgery 2017; 37 (07) 763-770
    CrossrefPubMedGoogle Scholar
  • 64 Mihara M, Hara H, Furniss D. et al Lymphaticovenular anastomosis to prevent cellulitis associated with lymphoedema. Br J Surg 2014; 101 (11) 1391-1396
    CrossrefPubMedGoogle Scholar
  • 65 Huang GK, Hu RQ, Liu ZZ, Shen YL, Lan TD, Pan GP. Microlymphaticovenous anastomosis in the treatment of lower limb obstructive lymphedema: analysis of 91 cases. Plast Reconstr Surg 1985; 76 (05) 671-685
    CrossrefPubMedGoogle Scholar
  • 66 Jacobson II JH, Suarez EL. Microvascular surgery. Dis Chest 1962; 41: 220-224
    CrossrefPubMedGoogle Scholar
  • 67 Gilbert A, O’Brien BM, Vorrath JW, Sykes PJ. Lymphaticovenous anastomosis by microvascular technique. Br J Plast Surg 1976; 29 (04) 355-360
    CrossrefPubMedGoogle Scholar
  • 68 Yamada Y. Studies on lymphatic venous anastomosis in lymphedema. Nagoya J Med Sci 1969; 32: 1-21
    Google Scholar
  • 69 Laine JB, Howard JM. Experimental lymphatico-venous anastomosis. Surg Forum 1963; 14: 111-112
    PubMedGoogle Scholar
  • 70 O’Brien BM, Sykes P, Threlfall GN, Browning FS. Microlymphaticovenous anastomoses for obstructive lymphedema. Plast Reconstr Surg 1977; 60 (02) 197-211
    CrossrefPubMedGoogle Scholar
  • 71 Koshima I, Inagawa K, Urushibara K, Moriguchi T. Supermicrosurgical lymphaticovenular anastomosis for the treatment of lymphedema in the upper extremities. J Reconstr Microsurg 2000; 16 (06) 437-442
    Article in Thieme ConnectPubMedGoogle Scholar
  • 72 Mihara M, Hara H, Kikuchi K. et al Scarless lymphatic venous anastomosis for latent and early-stage lymphoedema using indocyanine green lymphography and non-invasive instruments for visualising subcutaneous vein. J Plast Reconstr Aesthet Surg 2012; 65 (11) 1551-1558
    CrossrefPubMedGoogle Scholar
  • 73 Campisi C, Bellini C, Campisi C, Accogli S, Bonioli E, Boccardo F. Microsurgery for lymphedema: clinical research and long-term results. Microsurgery 2010; 30 (04) 256-260
    PubMedGoogle Scholar
  • 74 Yamamoto T, Yamamoto N, Yamashita M, Furuya M, Hayashi A, Koshima I. Efferent lymphatic vessel anastomosis: supermicrosurgical efferent lymphatic vessel-to-venous anastomosis for the prophylactic treatment of subclinical lymphedema. Ann Plast Surg 2016; 76 (04) 424-427
    CrossrefPubMedGoogle Scholar
  • 75 O’Brien BM, Mellow CG, Khazanchi RK, Dvir E, Kumar V, Pederson WC. Long-term results after microlymphaticovenous anastomoses for the treatment of obstructive lymphedema. Plast Reconstr Surg 1990; 85 (04) 562-572
    CrossrefPubMedGoogle Scholar
  • 76 Baumeister RG, Siuda S. Treatment of lymphedemas by microsurgical lymphatic grafting: what is proved?. Plast Reconstr Surg 1990; 85 (01) 64-74, discussion 75–76
    CrossrefPubMedGoogle Scholar
  • 77 Campisi C, Boccardo F. Microsurgical techniques for lymphedema treatment: derivative lymphatic-venous microsurgery. World J Surg 2004; 28 (06) 609-613
    PubMedGoogle Scholar
  • 78 Forte AJ, Huayllani MT, Boczar D, Ciudad P, Manrique O. Lipoaspiration and lymph node transfer for treatment of breast cancer-related lymphedema: a systematic review. Cureus 2019; 11 (11) e6096
    PubMedGoogle Scholar
  • 79 Engel H, Lin CY, Huang JJ, Cheng MH. Outcomes of lymphedema microsurgery for breast cancer-related lymphedema with or without microvascular breast reconstruction. Ann Surg 2018; 268 (06) 1076-1083
    CrossrefPubMedGoogle Scholar
  • 80 Pappalardo M, Patel K, Cheng MH. Vascularized lymph node transfer for treatment of extremity lymphedema: An overview of current controversies regarding donor sites, recipient sites and outcomes. J Surg Oncol 2018; 117 (07) 1420-1431
    CrossrefPubMedGoogle Scholar
  • 81 Demirtas Y, Ozturk N, Yapici O, Topalan M. Comparison of primary and secondary lower-extremity lymphedema treated with supermicrosurgical lymphaticovenous anastomosis and lymphaticovenous implantation. J Reconstr Microsurg 2010; 26 (02) 137-143
    Article in Thieme ConnectPubMedGoogle Scholar
  • 82 Nagase T, Gonda K, Inoue K. et al Treatment of lymphedema with lymphaticovenular anastomoses. Int J Clin Oncol 2005; 10 (05) 304-310
    CrossrefPubMedGoogle Scholar
  • 83 Seki Y, Yamamoto T, Yoshimatsu H. et al The Superior-Edge-of-the-Knee Incision Method in Lymphaticovenular Anastomosis for Lower Extremity Lymphedema. Plast Reconstr Surg 2015; 136 (05) 665e-675e
    CrossrefPubMedGoogle Scholar
  • 84 Suami H, Chang DW, Yamada K, Kimata Y. Use of indocyanine green fluorescent lymphography for evaluating dynamic lymphatic status. Plast Reconstr Surg 2011; 127 (03) 74e-76e
    CrossrefPubMedGoogle Scholar
  • 85 Yamamoto T, Koshima I, Yoshimatsu H, Narushima M, Miahara M, Iida T. Simultaneous multi-site lymphaticovenular anastomoses for primary lower extremity and genital lymphoedema complicated with severe lymphorrhea. J Plast Reconstr Aesthet Surg 2011; 64 (06) 812-815
    CrossrefPubMedGoogle Scholar
  • 86 Narushima M, Mihara M, Yamamoto Y, Iida T, Koshima I, Mundinger GS. The intravascular stenting method for treatment of extremity lymphedema with multiconfiguration lymphaticovenous anastomoses. Plast Reconstr Surg 2010; 125 (03) 935-943
    CrossrefPubMedGoogle Scholar
  • 87 Hara H, Mihara M, Seki Y, Todokoro T, Iida T, Koshima I. Comparison of indocyanine green lymphographic findings with the conditions of collecting lymphatic vessels of limbs in patients with lymphedema. Plast Reconstr Surg 2013; 132 (06) 1612-1618
    CrossrefPubMedGoogle Scholar
  • 88 Chen WF. How to Get Started Performing Supermicrosurgical Lymphaticovenular Anastomosis to Treat Lymphedema. Ann Plast Surg 2018; 81 (6S) (Suppl. 01) S15-S20
    CrossrefPubMedGoogle Scholar
  • 89 Yamamoto T, Yoshimatsu H, Yamamoto N. et al Modified lambda-shaped lymphaticovenular anastomosis with supermicrosurgical lymphoplasty technique for a cancer-related lymphedema patient. Microsurgery 2014; 34 (04) 308-310
    CrossrefPubMedGoogle Scholar
  • 90 Yamamoto T, Yoshimatsu H, Yamamoto N, Narushima M, Iida T, Koshima I. Side-to-end Lymphaticovenular anastomosis through temporary lymphatic expansion. PLoS One 2013; 8 (03) e59523
    CrossrefPubMedGoogle Scholar
  • 91 Yamamoto T, Yoshimatsu H, Narushima M, Yamamoto N, Koshima I. Split intravascular stents for side-to-end lymphaticovenular anastomosis. Ann Plast Surg 2013; 71 (05) 538-540
    CrossrefPubMedGoogle Scholar
  • 92 AlJindan FK, Lin CY, Cheng MH. Comparison of outcomes between Side-to-End and End-to-End Lymphovenous Anastomoses for Early-Grade Extremity Lymphedema. Plast Reconstr Surg 2019; 144 (02) 486-496
    CrossrefPubMedGoogle Scholar
  • 93 Nuri T, Ueda K, Yamada A, Hara M. Preparatory intravascular stenting technique: an easier method of supermicrosurgical lymphaticovenular anastomosis. Ann Plast Surg 2013; 71 (05) 541-543
    CrossrefPubMedGoogle Scholar
  • 94 Ciudad P, Sabbagh MD, Agko M. et al Surgical management of lower extremity lymphedema: a comprehensive review. Indian J Plast Surg 2019; 52 (01) 81-92
    Article in Thieme ConnectPubMedGoogle Scholar
  • 95 Scaglioni MF, Uyulmaz S, Arvanitakis M, Lineaweaver WC. Zhang F Intraoperatively detected but previously indocyanine green-negative lymphatic vessels may have misprized potentials and should not be neglected in lymphaticovenous bypass surgery. Annals of plastic surgery 2019; 83 (01) 63-72
    CrossrefPubMedGoogle Scholar
  • 96 Yoshimatsu H, Yamamoto T, Narushima M, Iida T, Koshima I. The guide wire method: a new technique for easier side-to-end lymphaticovenular anastomosis. Annals of plastic surgery 2014; 73 (02) 231-233
    CrossrefPubMedGoogle Scholar
  • 97 Akita S, Mitsukawa N, Kuriyama M. et al Suitable therapy options for sub-clinical and early-stage lymphoedema patients. J PLAST RECONSTR AES 2014; 67 (04) 520-525
    CrossrefPubMedGoogle Scholar
  • 98 Akita S. et al External valvuloplasty for subcutaneous small veins to prevent venous reflux in lymphaticovenular anastomosis for lower extremity lymphedema. Plast Reconstr Surg 2013; 132 (04) 1008-1014
    CrossrefPubMedGoogle Scholar
  • 99 Maegawa J, Yabuki Y, Tomoeda H, Hosono M , Yasumura K. Outcomes of lymphaticovenous side-to-end anastomosis in peripheral lymphedema. J Vasc Surg 2012; 55 (03) 753-760
    CrossrefPubMedGoogle Scholar
  • 100 Motegi S, Tamura A, Okada E, Nagai Y , Ishikawa O. Successful treatment with lymphaticovenular anastomosis for secondary skin lesions of chronic lymphedema. Dermatology 2007; 215 (02) 147-151
    CrossrefPubMedGoogle Scholar