Breast Cancer Research and Treatment

, Volume 113, Issue 2, pp 199–206 | Cite as

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

  • R. J. DamstraEmail author
  • H. G. J. Voesten
  • W. D. van Schelven
  • B. van der Lei


Objective The incidence of breast cancer related lymphedema (BCRL) varies between 7-35% depending on the combination of treatment modalities. Early detection of BCRL is crucial in order to start an effective non-operative treatment program. Because of the lack of prospective research on this topic, this study was undertaken to prospectively determine the effect of Lympho Venous Anastomosis (LVA) on BCRL and to review the current literature. Study design and methods Ten patients who were previously treated for breast cancer by surgery, radiotherapy, and chemotherapy, and were unresponsive to 12-weeks of non-operative treatment, underwent an LVA procedure (Degni-Cordeiro). Objective measurements were gathered for circumferential measurement and water volumetry, and quality of life. Various types of lymphoscintigraphy were carried out pre-operatively and post-operatively at 3 and 12 months. Treatment was embedded in a multidisciplinary setting. Results Post-operative volume measurements initially showed a 4.8% reduction of lymphedema at 3 months and a 2% reduction after one year. Various scintigraphic parameters showed some improvement. Quality of life questionnaires reported minimal improvement. Reviewing the literature, only retrospective studies were found; these reported varying results for LVA procedures. The selection of patients, classification of lymphedema, indications and types of LVA, and additional therapeutic options were heterogeneous, not comparable, and lacked a validated method of effect-assessment. Conclusions Our results showed a minimal reduction in volume of lymphedema following LVA; in the literature, there was no convincing evidence of the success of LVA. Non-operative treatment and elastic stockings are still preferred by most patients with lymphedema, especially in early stages with few irreversible changes.


Lympho-venous anastomosis (LVA) Microsurgery Evidence-based medicine Lymphoscintigraphy Inverse water volumetry Review Breast cancer related lymphedema 



Contributions R.J. Damstra was the lead author in the overall conceptualization and design of the study and the manuscript. He collected the data and prepared the databases. H.G.J Voesten participated in revising and editing the text. W.D. van Schelven participated in the design and the execution of the (semi) quantitative scintigraphic studies, as well as the analysis and the interpretation of the scans. He had the primary responsibility for the scintigraphic paragraphs. B. van de Lei performed all microsurgical procedures, participated in drafting the text and provided overall supervision of the manuscript.


  1. 1.
    Brorson H, Ohlin K, Olsson G, Nilsson M (2006) Adipose tissue dominates chronic arm lymphedema following breast cancer: an analysis using volume rendered CT images. Lymphat Res Biol 4(4):199–210PubMedCrossRefGoogle Scholar
  2. 2.
    Mortimer PS (1997) Therapy approaches for lymphedoedema. Angiology 48(1):87–91PubMedCrossRefGoogle Scholar
  3. 3.
    O’Brien BM, Sykes PJ, Threlfall GN, Browning FS (1977) Microlymphaticovenous anastomoses for obstructive lymphedema. Plast Reconstr Surg 60(2):197–211PubMedCrossRefGoogle Scholar
  4. 4.
    Campisi C, Boccardo F, Zilli A, Maccio A (2001) the use of vein grafts in the treatment of peripheral lymphedemas: long term results. Microsusrgery 21(4):143–147CrossRefGoogle Scholar
  5. 5.
    Baumeister RGH, Frick A (1996) Die autogen gefasstransplantation zur microchirurgischen Rekonstruktion des Lymphgefassysteems. Phlebol 25:83–88Google Scholar
  6. 6.
    Aaronson NK, Muller M, Cohen PD, Essink-Bot ML, Fekkes M, Sanderman R, Sprangers MA, te Velde A, Verrips E (1998) Translation, validation, and norming of the Dutch language version of the SF-36 health survey in community and chronic disease populations. J Clin Epidemiol 51(11):1055–1068PubMedCrossRefGoogle Scholar
  7. 7.
    Damstra RJ, Glazenburg E, Hol W (2006) The validation of the inverse water volumetry: New gold standard for arm volume measurement. Breast Cancer Res Treat 99(3):267–273PubMedCrossRefGoogle Scholar
  8. 8.
    Herpertz U (1994) Messung und Dokumentation von Ödemen. Lymphologie 18:24–30Google Scholar
  9. 9.
    Vignes S, Boursier v, Priollet P, Miserey G, Trévidic P (2003) Quantitative evaluation and qualitative results of surgical lymphovenous anastomosis in lower limb lymphedema. J Mal Vasc 28(1):30–35PubMedGoogle Scholar
  10. 10.
    Kleinhans E, Baumeister RGH, Hahn D, Siuda S, Bull U, Moser E (1985) Evaluation of transport kinetics in lymphoscintigraphy: follow-up study in patients with transplanted lymphatic vessels. Eur J Nucl Med 10:349–352PubMedCrossRefGoogle Scholar
  11. 11.
    Degni M (1981) New techniques of lymphatic-venous anastomosis for the treatment of lymphedema. Lymphlology 14(2):61–63Google Scholar
  12. 12.
    Brorson H (2003) Liposuction in arm lymphedema treatment. Scand J Surg 92(4):287–295PubMedGoogle Scholar
  13. 13.
    O’Brien BC, Shafiroff BB (1979) Microlymphaticovenous and resectional surgery in obstructive lymphedema. World J Surg 3(1):3–15PubMedCrossRefGoogle Scholar
  14. 14.
    Filippetti M, Santoro E, Graziano F, Petric M, Rinaldi G (1994) Modern approaches to postmastectomy brachial lymphedema. Microsurgery 15(8):604–606PubMedCrossRefGoogle Scholar
  15. 15.
    Cruchten LH van, Nieuborg L (1995) Diagnose en behandeling van lymfoedeem. Ned Tijdschr Geneeskd 138:653–657Google Scholar
  16. 16.
    Campisi C, Boccardo F, Alitta P, Tachella M (1995) Derivative lymphatic microsurgery: indications, techniques and results. Microsurgery 16(7):463–468PubMedCrossRefGoogle Scholar
  17. 17.
    Huang GK (1989) Ergebnisse microchirurgischer lymphvenöser Anastomosen bei Lymphödemen Bericht über 110 Fälle. Langenbecks Arch Chir 374:194–199PubMedCrossRefGoogle Scholar
  18. 18.
    Yamamoto Y, Sugihara T (1998) Microsurgical lymphaticovenous implantaton for the treatment of chronic lymphedema. Plast Reconstr Surg 101(1):157–159PubMedCrossRefGoogle Scholar
  19. 19.
    Koshima I, Nanba Y, Tstsuya T, Takahahi Y, itoh S, Fujitsu M (2004) Minimal invasive lymphaticovenular anastomosis under local anesthesia for leg lymphedema. Is it effective for stage III and IV?. Ann Plast Surg 53:261–266PubMedCrossRefGoogle Scholar
  20. 20.
    Matsubara S, Sakuda H, Nakaema M, Kuniyosh Y (2006) Long term results of microscopic lymphatic vessel isolated vein anastomosis for secondary lymphedema of the lower extremities. Surg Today 36:859–864PubMedCrossRefGoogle Scholar
  21. 21.
    Campisi C, Davini D, Bellini C, Taddei G, Villa G, Fulcheri E, Zilli A, Da Rin E, Eretta C, Boccardo F (2006) Lymphatic microsurgery for the treatment of lymphedema. Microsurgery 26:65–69PubMedCrossRefGoogle Scholar
  22. 22.
    Földi E, Földi M, Clodius L (1989) The lymphedema chaos: a lancet. Ann Plast Surg 22(5):148–151Google Scholar
  23. 23.
    Szuba A, Cooke JP, Youuf S, Rockson SG (2000) Decongestive lymphatic therapy for patients with cancer related or primary lymphedema. AM J Med 109:296–300PubMedCrossRefGoogle Scholar
  24. 24.
    Campisi C, Eretta C, Pertile D, Dan Rin D, Campisi C et al (2007) Microsurgery for treatment of peripheral lymphedema: long term outcome and future perspectives. Microsurgery 27(4):333–338PubMedCrossRefGoogle Scholar
  25. 25.
    Baumeister RG, Siuda S (1990) Treatment of lymphedemas by microsurgical lymphatic grafting: what is proved? Plast Reconstr Surg 85:64–76PubMedCrossRefGoogle Scholar
  26. 26.
    Weiss M, Baumeister RGH, Hahn K (2002) Post-therapeutic lymphedema: scintigraphy before and after autologous lymph vessel transplantation; 8 years of long-term follow-up. Clin Nucl Med 27:788–792PubMedCrossRefGoogle Scholar
  27. 27.
    Vaqueiro M, Gloviczki P, Fisher J, Hollier LH, Schirger A, Wahner HW (1986) Lymphoscintigraphy in lymphedema: an aid to microsurgery. J Nucl Med 27:1125–1130PubMedGoogle Scholar
  28. 28.
    Yuan Z, Chen L, Zhu J, Lu H, Zhu R (2006) The role of radionuclide lymphoscintigraphy in extremity lymphedema. Ann Nucl Med 20(5):341–344PubMedCrossRefGoogle Scholar
  29. 29.
    Scarsbrook AF, Ganeshan A, Bradley KM (2007) Pearls and pitfalls of radionuclide imaging of the lymphatic system: part 2: evaluation of extremity lymphedema. Br J Radiol 80(951):219–226PubMedCrossRefGoogle Scholar
  30. 30.
    Ketterings C, Zeddeman S (1997) Use of the C-scan in evaluation of peripheral lymphedema. Lymphology 30:49–62PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2008

Authors and Affiliations

  • R. J. Damstra
    • 1
    Email author
  • H. G. J. Voesten
    • 2
  • W. D. van Schelven
    • 3
  • B. van der Lei
    • 4
  1. 1.Department of Dermatology, Phlebology and LymphologyNij Smellinghe HospitalDrachtenThe Netherlands
  2. 2.Department of SurgeryNij Smellinghe HospitalDrachtenThe Netherlands
  3. 3.Department of Nuclear MedicineMedical Centre LeeuwardenLeeuwardenThe Netherlands
  4. 4.Department of Plastic Reconstructive, Aesthetic and Hand SurgeryUniversity Medical Centre GroningenGroningenThe Netherlands

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