Comparison of lymphovenous anastomosis and vascularized lymph node transfer in lymphedema treatment - a literature review.

Abstract

Background: Lymphovenous anastomosis (LVA) and vascularized lymph node transfer (VLNT) are both accepted microsurgical treatment options for lymphedema. This article summarises and analyses recent data on outcomes associated with LVA and VLNT for lymphedema treatment at varying degrees of severity.

Methods: Literature research was conducted in the PubMed and Embase Ovid database to extract articles published through March 2024. The included studies report data on objective and subjective improvement in lymphedema after physiological surgical procedures as LVA and VLNT. Extracted data comprised number of patients, affected limbs, staging of the disease, duration of the follow up period, objective and subjective improvement and percentage of discontinuation of compression garments.

Results: A total of 23 articles were included in this article, representing 1,944 patients suffering from either primary or secondary lymphedema. The lymphedema stages were classified by classification of International Society of Lymphedema (ISL stage) or Campisi stage and range from stage I to III, as well as prophylactic indication for surgery. The follow-up duration ranged from 3 months to 8 years. Objective improvement was achieved in 82.76-100% and measured in circumferential reduction rate and reduction of cellulitis episodes. In 80-100% of the patient's subjective improvement was seen, which was measured in quality of life and personal feedback. The percentage of patients able to discontinue the use of compression garments ranges from 0 to 100%, while others were able to reduce the total time of wearing.

Conclusion: LVA and VLNT are both safe and effective techniques for the surgical treatment of lymphedema in several stages. LVA should be preferred if the lymph vessels preserved its patency, otherwise VLNT might be the therapy of choice. Combinations of various procedures with an appropriate postoperative treatment plan might lead to improved patient outcomes.