Predicting the Outcome of Lymphovenous Anastomosis for Lower Extremity Lymphedema through Lymphoscintigraphy.

Abstract

Background: Lymphovenous anastomosis (LVA) is an effective treatment for restoring lymphatic function in patients with lymphedema. This study aimed to assess the predictive value of preoperative lymphoscintigraphy in female patients undergoing LVA for lower extremity lymphedema (LEL). Methods: Female patients with unilateral LEL who underwent preoperative lymphoscintigraphy followed by LVA were retrospectively examined. In the lymphoscintigraphy, the transport index (TI) was calculated based on five visual interpretation criteria: lymphatic transport kinetics, dermal backflow pattern, time to appearance of lymph nodes, visualization of lymph nodes, and visualization of vessels. For volume assessment, the LEL index (LELI) was calculated as the sum of circumferences at five predefined sites of the lower extremity, divided by body mass index. LELI was measured before and after LVA at 1, 3, and 6 months. Postoperative changes in LELI were compared with preoperative variables, including TI. Results: The study included 45 female patients (mean age 56 ± 10 years) with unilateral LEL, of whom 78% had clinical stage 3 lymphedema. The mean TI of the affected lower extremities at 240 and 120 min was 25.5 ± 11.0 and 26.5 ± 11.1, respectively. TI was significantly associated with clinical stage and preoperative volume excess. Postoperatively, the mean LELI reduction was 7 ± 5% at 1 month, 8 ± 5% at 3 months, and 6 ± 7% at 6 months. Significant negative correlations were found between the TI at both 240 and 120 min and postoperative LELI changes at 3 and 6 months (p < 0.05). Conclusions: Preoperative lymphoscintigraphy, specifically the TI, is valuable for assessing the severity of lymphedema and predicting short-term outcomes of LVA in female patients with LEL. The TI can be calculated from lymphoscintigraphy performed up to 2 h.