Water Reductive Effect of Lymphaticovenular Anastomosis on Upper-Limb Lymphedema: Bioelectrical Impedance Analysis and Comparison with Lower-Limb LymphedemaFunding None.
Background We previously examined the water reductive effect of lymphaticovenular anastomosis (LVA) using bioelectrical impedance analysis (BIA) measurement on lower-limb lymphedema and revealed mean water volume reduction and edema reduction rate by leg LVA to be 0.86 L and 45.1%, respectively. This study aimed to clarify the water reductive effect of LVA on arm lymphedema and compare its results with those for leg lymphedema.
Patients and Methods The efficacy of LVA for unilateral arm lymphedema was evaluated using BIA in a retrospective cohort. Limb circumference and arm body water volume (ABW) of the affected and unaffected arms were measured before and after LVA. Mean water volume reduction (ΔABW) and edema reduction rate by arm LVA were compared with values for leg LVA cited from our previous report as a historical control.
Results Nineteen consecutive patients were enrolled. The mean ΔABW and edema reduction rate by BIA were 0.267 L and 46.0%, respectively. The decreasing rate of ABW by BIA was significantly larger than those of the upper extremity lymphedema index and sum of 5 circumferences measurement methods. ΔABW could be predicted by a regression line based on the preoperative water volume difference between affected and unaffected limbs. The mean edema reduction rates for arm and leg LVA were comparable.
Conclusion The water reductive effect of LVA on upper-limb lymphedema was demonstrated by BIA assessment. BIA can reflect the effect of LVA more sensitively than conventional objective measurements and may facilitate the interpretation of LVA results. Although water volume reduction by arm LVA was less than that by leg LVA, the edema reduction rates were comparable.
This study was presented in part at the 46th Annual Meeting of the Japanese Society of Reconstructive Microsurgery in Tokyo, Japan, November 29, 2019.
Received: 04 February 2020
Accepted: 13 May 2020
13 July 2020 (online)
© 2020. Thieme. All rights reserved.
Thieme Medical Publishers
333 Seventh Avenue, New York, NY 10001, USA.
- 1 Casley-Smith JR. Measuring and representing peripheral oedema and its alterations. Lymphology 1994; 27 (02) 56-70
- 2 Yamamoto T, Matsuda N, Todokoro T. , et al. Lower extremity lymphedema index: a simple method for severity evaluation of lower extremity lymphedema. Ann Plast Surg 2011; 67 (06) 637-640
- 3 Yamamoto T, Yamamoto N, Hara H, Mihara M, Narushima M, Koshima I. Upper extremity lymphedema index: a simple method for severity evaluation of upper extremity lymphedema. Ann Plast Surg 2013; 70 (01) 47-49
- 4 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
- 5 Ancukiewicz M, Russell TA, Otoole J. , et al. Standardized method for quantification of developing lymphedema in patients treated for breast cancer. Int J Radiat Oncol Biol Phys 2011; 79 (05) 1436-1443
- 6 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
- 7 Batista BN, Baiocchi JMT, Campanholi LL, Bergmann A, Duprat JP. Agreement between perometry and sequential arm circumference measurements in objective determination of arm volume. J Reconstr Microsurg 2018; 34 (01) 29-34
- 8 Executive Committee. The diagnosis and treatment of peripheral lymphedema: 2016 Consensus document of the International Society of Lymphology. Lymphology 2016; 49 (04) 170-184
- 9 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
- 10 Ichinose Y, Yasunaga Y, Yuzuriha S. Rheumatoid lymphedema successfully treated with lymphaticovenular anastomosis: a case report. J Reconstr Microsurg Open 2019; 4: e24-e28 DOI: 10.1055/s-0039-1688763.
- 11 Yamamoto T, Yamamoto N, Hayashi A, Koshima I. Supermicrosurgical deep lymphatic vessel-to-venous anastomosis for a breast cancer-related arm lymphedema with severe sclerosis of superficial lymphatic vessels. Microsurgery 2017; 37 (02) 156-159
- 12 Kushner RF. Bioelectrical impedance analysis: a review of principles and applications. J Am Coll Nutr 1992; 11 (02) 199-209
- 13 Ng BK, Liu YE, Wang W. , et al. Validation of rapid 4-component body composition assessment with the use of dual-energy X-ray absorptiometry and bioelectrical impedance analysis. Am J Clin Nutr 2018; 108 (04) 708-715
- 14 Damstra RJ, Voesten HG, van Schelven WD, van der Lei B. Lymphatic venous anastomosis (LVA) for treatment of secondary arm lymphedema. A prospective study of 11 LVA procedures in 10 patients with breast cancer related lymphedema and a critical review of the literature. Breast Cancer Res Treat 2009; 113 (02) 199-206
- 15 Chang DW. Lymphaticovenular bypass for lymphedema management in breast cancer patients: a prospective study. Plast Reconstr Surg 2010; 126 (03) 752-758
- 16 Winters H, Tielemans HJP, Hameeteman M. , et al. The efficacy of lymphaticovenular anastomosis in breast cancer-related lymphedema. Breast Cancer Res Treat 2017; 165 (02) 321-327
- 17 Winters H, Tielemans HJP, Verhulst AC, Paulus VAA, Slater NJ, Ulrich DJO. The long-term patency of lymphaticovenular anastomosis in breast cancer-related lymphedema. Ann Plast Surg 2019; 82 (02) 196-200
- 18 Phillips GSA, Gore S, Ramsden A, Furniss D. Lymphaticovenular anastomosis improves quality of life and limb volume in patients with secondary lymphedema after breast cancer treatment. Breast J 2019; 25 (05) 859-864
- 19 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
- 20 Klingelhoefer E, Hesse K, Taeger CD, Prantl L, Stepniewski A, Felmerer G. Factors affecting outcomes after supermicrosurgical lymphovenous anastomosis in a defined patient population. Clin Hemorheol Microcirc 2019; 73 (01) 53-63
- 21 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