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Surgery Today

, Volume 36, Issue 10, pp 859–864 | Cite as

Long-Term Results of Microscopic Lymphatic Vessel-Isolated Vein Anastomosis for Secondary Lymphedema of the Lower Extremities

  • Shinobu Matsubara
  • Hitoshi Sakuda
  • Moriyasu Nakaema
  • Yukio Kuniyoshi
Original Articles

Abstract

Purpose

To evaluate the effectiveness of microscopic lymphatic vessel-isolated vein anastomosis in patients with secondary obstructive lymphedema of a lower extremity, refractory to nonoperative management.

Methods

Nine women suffered from nonpitting edema of one or both legs (11 limbs) after radical hysterectomy with postoperative irradiation for uterine cancer. The indications for this operation were repeated cellulitis and severe nonpitting edema impairing limb function. Under microscopy of 3.2 on average, the identified lymphatic vessels were anastomosed to an isolated saphenous vein using the pull-through technique with modifications.

Results

The follow-up period ranged from 21 to 87 months and the operation achieved excellent reduction, of more than 5 cm, in six limbs; good reduction, of 2–5 cm, in two limbs; and poor reduction, of less than 2 cm, in three limbs. The frequency of cellulitis decreased from 2.4 infections per patient per year to 0.2 infections per patient per year.

Conclusion

These results show that microscopic lymphatic vessel-isolated vein anastomosis is a minimally invasive operation, with good long-term effects, making it the treatment of choice for intractable secondary lymphedema of the lower extremities refractory to physiotherapy.

Key words

Secondary lymphedema Microscopic lymphatic vessel-isolated vein anastomosis 

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References

  1. 1.
    Gloviczki, P 1999Principles of surgical treatment of chronic lymphoedemaInt Angiol18426PubMedGoogle Scholar
  2. 2.
    Kinjo, O, Kusaba, A 1995Lymphatic vessel-to-isolated-vein anastomosis for secondary lymphedema in a canine modelSurg Today256339PubMedCrossRefGoogle Scholar
  3. 3.
    International Society of Lymphology2003The diagnosis and treatment of peripheral lymphedema. Consensus document of the International Society of LymphologyLymphology368491Google Scholar
  4. 4.
    Degni, M 1981New microsurgical technique of lymphatico-venous anastomosis for the treatment of lymphedemaLymphology14613PubMedGoogle Scholar
  5. 5.
    Sakuda, H, Nakaema, M, Matsubara, S, Higa, N, Kamada, Y, Kuniyoshi, Y,  et al. 2002Air plethysmographic assessment of external valvuloplasty in patients with valvular incompetence of the saphenous and deep veinsJ Vasc Surg369227PubMedCrossRefGoogle Scholar
  6. 6.
    Ryan, M, Stainton, MC, Slaytor, EK, Jaconelli, C, Watts, S, Mackenzie, P 2003Aetiology and prevalence of lower limb lymphoedema following treatment for gynaecological cancerAust N Z J Obstet Gynaecol4314851PubMedCrossRefGoogle Scholar
  7. 7.
    Foldi, E, Foldi, M, Clodius, L 1989The lymphedema chaos: a lancetAnn Plast Surg2250515PubMedCrossRefGoogle Scholar
  8. 8.
    Lerner, R 1998What's new in lymphedema therapy in America?Int J Angiol71916PubMedGoogle Scholar
  9. 9.
    Ko, DS, Lerner, R, Klose, G, Cosimi, AB 1998Effective treatment of lymphedema of the extremitiesArch Surg1334528PubMedCrossRefGoogle Scholar
  10. 10.
    Szuba, A, Cooke, JP, Yousuf, S, Rockson, SG 2000Decongestive lymphatic therapy for patients with cancer related or primary lymphedemaAm J Med109296300PubMedCrossRefGoogle Scholar
  11. 11.
    Campisi, C, Boccardo, F, Zilli, A, Maccio, A, Gariglio, A, Schenone, F 2003Peripheral lymphedema: new advances in microsurgical treatment and long-term outcomeMicrosurgery235225PubMedCrossRefGoogle Scholar
  12. 12.
    Baumeister, RG, Siuda, S 1990Treatment of lymphedemas by microsurgical lymphatic grafting: what is proved?Plast Reconstr Surg856474PubMedGoogle Scholar
  13. 13.
    Olszewski, WL 1988The treatment of lymphedema of the extremities with microsurgical lympho-venous anastomosesInt Angiol731221PubMedGoogle Scholar
  14. 14.
    Calderon, G, Roberts, B, Johnson, LL 1967Experimental approach to the surgical creation of lymphatic-venous communicationsSurgery611228PubMedGoogle Scholar
  15. 15.
    Gloviczki, P, Hollier, LH, Nora, FE, Kaye, MP 1986The natural history of microsurgical lymphovenous anastomoses: an experimental studyJ Vasc Surg414856PubMedCrossRefGoogle Scholar
  16. 16.
    Campisi, C, Boccardo, F 2002Lymphedema and microsurgeryMicrosurgery227480PubMedCrossRefGoogle Scholar
  17. 17.
    Campisi, C, Boccardo, F 2004Microsurgical techniques for lymphedema treatment: derivative lymphatic-venous microsurgeryWorld J Surg2860913PubMedCrossRefGoogle Scholar
  18. 18.
    O'Brien, BM, Mellow, CG, Khazanchi, RK, Dvir, E, Kumar, V, Pederson, WC 1990Long-term results after microlymphaticovenous anastomoses for the treatment of obstructive lymphedemaPlast Reconstr Surg8556272PubMedCrossRefGoogle Scholar
  19. 19.
    Gloviczki, P, Fisher, J, Hollier, LH, Pairolero, PC, Schirger, A, Wahner, HW 1988Microsurgical lymphovenous anastomosis for treatment of lymphedema: a critical reviewJ Vasc Surg764752PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Tokyo 2006

Authors and Affiliations

  • Shinobu Matsubara
    • 1
  • Hitoshi Sakuda
    • 1
  • Moriyasu Nakaema
    • 1
  • Yukio Kuniyoshi
    • 1
  1. 1.Thoracic and Cardiovascular Surgery, Department of Bioregulatory MedicineFaculty of Medicine, University of the RyukyusOkinawaJapan

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