Abstract
Lymphedema is a progressive edematous disease due to abnormal lymph circulation. Most lymphedema cases are secondary to lymph flow obstruction. Obstruction of lymph flow causes hypertension and dilatation of distal lymph vessels, resulting in lymphatic valvular insufficiency and further retrograde lymph flows. Since irreversible changes occur in the lymph vessels (lymphosclerosis) and soft tissue (fat deposition and fibrosis) with progression of lymphedema, lymph circulation should be improved at an early stage. Although a mainstay of treatment, compression therapy is merely an anti-symptomatic one and cannot stop progression of lymphedema. Lymph reconstructive surgery is required to improve lymph circulation.
Among various surgeries, supermicrosurgical lymphaticovenular anastomosis (LVA) is a least invasive surgery effective for progressive lymphedema. LVA can be done under local infiltration anesthesia via a 2-cm skin incision without hospitalization. However, LVA is hardly effective for progressed lymphedema complicated with severe lymphosclerosis. Early diagnosis is the most important to maximize the efficacy of the minimally invasive surgery. Indocyanine green (ICG) lymphography is recommended for early diagnosis, since it has the highest sensitivity to detect abnormal circulation. ICG lymphography and LVA are key to successful management of lymphedema.
Similar content being viewed by others
References
Baulieu F, Bourgeois P, Maruani A, Belgrado JP, Tauveron V, Lorette G, Vaillant L. Contributions of SPECT/CT imaging to the lymphoscintigraphic investigations of the lower limb lymphedema. Lymphology. 2013;46(3):106–19.
Yamamoto T, Matsuda N, Todokoro T, Yoshimatsu H, Narushima M, Mihara M, Uchida G, Koshima I. Lower extremity lymphedema index: a simple method for severity evaluation of lower extremity lymphedema. Ann Plast Surg. 2011a;67(6):637–40.
Yamamoto T, Narushima M, Doi K, Oshima A, Ogata F, Mihara M, Koshima I, Mundinger GS. Characteristic indocyanine green lymphography findings in lower extremity lymphedema: the generation of a novel lymphedema severity staging system using dermal backflow patterns. Plast Reconstr Surg. 2011b;127(5):1979–86.
Yamamoto T, Narushima M, Kikuchi K, Yoshimatsu H, Todokoro T, Mihara M, Koshima I. Lambda-shaped anastomosis with intravascular stenting method for safe and effective lymphaticovenular anastomosis. Plast Reconstr Surg. 2011c;127(5):1987–92.
Yamamoto T, Yamamoto N, Doi K, Oshima A, Yoshimatsu H, Todokoro T, Ogata F, Mihara M, Narushima M, Iida T, Koshima I. Indocyanine green (ICG)-enhanced lymphography for upper extremity lymphedema: a novel severity staging system using dermal backflow (DB) patterns. Plast Reconstr Surg. 2011d;128(4):941–7.
Yamamoto T, Matsuda N, Doi K, Oshima A, Yoshimatsu H, Todokoro T, Ogata F, Mihara M, Narushima M, Iida T, Koshima I. The earliest finding of indocyanine green (ICG) lymphography in asymptomatic limbs of lower extremity lymphedema patients secondary to cancer treatment: the modified dermal backflow (DB) stage and concept of subclinical lymphedema. Plast Reconstr Surg. 2011e;128(4):314e–21e.
Yamamoto T, Yamamoto N, Hara H, Mihara M, Narushima M, Koshima I. Upper extremity lymphedema (UEL) index: a simple method for severity evaluation of upper extremity lymphedema. Ann Plast Surg. 2013a;70(1):47–9.
Yamamoto T, Yoshimatsu H, Narushima M, Seki Y, Yamamoto N, Shim TWH, Koshima I. A modified side-to-end lymphaticovenular anastomosis. Microsurgery. 2013b;33(2):130–3.
Yamamoto T, Yoshimatsu H, Narushima M, Yamamoto N, Koshima I. Split intravascular stents for side-to-end lymphaticovenular anastomosis. Ann Plast Surg. 2013c;71(5):538–40.
Yamamoto T, Yoshimatsu H, Yamamoto N, Narushima M, Iida T, Koshima I. Side-to-end lymphaticovenular anastomosis through temporary lymphatic expansion. PLoS One. 2013d;8(3):e59523. Epub 2013 Mar 25
Yamamoto T, Narushima M, Yoshimatsu H, Seki Y, Yamamoto N, Oka A, Hara H, Koshima I. Minimally invasive lymphatic supermicrosurgery (MILS): indocyanine green lymphography-guided simultaneous multi-site lymphaticovenular anastomoses via millimeter skin incisions. Ann Plast Surg. 2014a;72(1):67–70.
Yamamoto T, Yoshimatsu H, Narushima M, Yamamoto N, Shim TWH, Seki Y, Kikuchi K, Karibe J, Azuma S, Koshima I. Sequential anastomosis for lymphatic supermicrosurgery: multiple lymphaticovenular anastomoses on one venule. Ann Plast Surg. 2014b;73(1):46–9.
Yamamoto T, Yamamoto N, Numahata T, Yokoyama A, Tashiro K, Yoshimatsu H, Narushima M, Kohima I. Navigation lymphatic supermicrosurgery for the treatment of cancer-related peripheral lymphedema. Vasc Endovasc Surg. 2014c;48(2):139–43.
Yamamoto T, Yoshimatsu H, Koshima I. Navigation lymphatic supermicrosurgery for iatrogenic lymphorrhea: supermicrosurgical lymphaticolymphatic anastomosis and lymphaticovenular anastomosis under indocyanine green lymphography navigation. J Plast Reconstr Aesthet Surg. 2014d;67(11):1573–9.
Yamamoto T, Yoshimatsu H, Narushima M, Yamamoto N, Hayashi A, Koshima I. Indocyanine green lymphography findings in primary leg lymphedema. Eur J Vasc Endovasc Surg. 2015;49:95–102.
Yamamoto T, Yamamoto N, Hayashi N, Hayashi A, Koshima I. Practicality of lower extremity lymphedema index: lymphedema index versus volumetry-based evaluations for body-type corrected lower extremity volume evaluation. Ann Plast Surg. 2016a;77(1):115–8.
Yamamoto T, Saito T, Ishiura R, Iida T. Quadruple-component superficial circumflex iliac artery perforator (SCIP) flap: a chimeric SCIP flap for complex ankle reconstruction of an exposed artificial joint after total ankle arthroplasty. J Plast Reconstr Aesthet Surg. 2016b;69(9):1260–5.
Yamamoto T, Yamamoto N, Yamashita M, Furuya M, Hayashi A, Koshima I. Efferent lymphatic vessel anastomosis (ELVA): supermicrosurgical efferent lymphatic vessel-to-venous anastomosis for the prophylactic treatment of subclinical lymphedema. Ann Plast Surg. 2016c;76(4):424–7.
Yamamoto T, Yamamoto N, Yoshimatsu H, Narushima M, Koshima I. Factors associated with lymphosclerosis: an analysis on 962 lymphatic vessels. Plast Reconstr Surg. 2017;140(4):734–41.
Yamamoto T, Narushima M, Koshima I. Lymphatic vessel diameter in female pelvic cancer-related lower extremity lymphedematous limbs. J Surg Oncol. 2018a;117(6):1157–1163.
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. Plast Reconstr Surg. 2018b;142(6):924e–930e.
Zeltzer AA, Brussaard C, Koning M, De Baerdemaeker R, Hendrickx B, Hamdi M, de Mey J. MR lymphography in patients with upper limb lymphedema: the GPS for feasibility and surgical planning for lympho-venous bypass. J Surg Oncol. 2018;118(3):407–15.
Author information
Authors and Affiliations
Corresponding author
Section Editor information
Rights and permissions
Copyright information
© 2020 Springer Nature Switzerland AG
About this entry
Cite this entry
Yamamoto, T. (2020). Supermicrosurgical Lymphaticovenular Anastomosis (LVA) for Early-Stage (Stage 1–2) Extremity Lymphedema. In: Clinical Scenarios in Reconstructive Microsurgery. Springer, Cham. https://doi.org/10.1007/978-3-319-94191-2_110-1
Download citation
DOI: https://doi.org/10.1007/978-3-319-94191-2_110-1
Received:
Accepted:
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-94191-2
Online ISBN: 978-3-319-94191-2
eBook Packages: Springer Reference MedicineReference Module Medicine