Gennaro, P., Gabriele, G., Mihara, M., Kikuchi, K., Salini, C., Aboh, I., . . . Ungari, C. (2016). Supramicrosurgical lymphatico-venular anastomosis (LVA) in treating lymphoedema: 36-months preliminary report. European Review for Medical and Pharmacological Sciences, 20, 4642–4653.

Study Purpose

To evaluate the effects of lymphaticovenular anastomosis (LVA) on patients with lymphedema

Intervention Characteristics/Basic Study Process

A retrospective research study of 36-months of follow-up of 69 patients with lymphedema after LVA surgery. Each had a preoperative ultrasound with an echo-color doppler. Results were not discussed in the study, neither did it state why these were done.

Each patient was measured bilaterally with 5 circumferential measurement points. Sums were compared pre- and postoperatively and then at multiple intervals throughout 36 months.

Upper extremity: hand, wrist, elbow, 5 cm distal and 5 cm proximal to the elbow

Lower extremity: dorsum of the foot, ankle, the knee, 10 cm distal and 10 cm proximal to the knee

Pre- and postoperative indocyanine green dye (ICG) lymphography: Each patient had an ICG lymphography, which is injected into the distal extremity, involving an infrared light issues to visualize the lymphatics. After the intervention, patients evaluated their quality of life and lymphedema. They were evaluated again at two weeks, one month, and every six months after surgery. Patients started lymph drainage postoperatively. Patients wore compression for one year after the surgery.

Sample Characteristics

N = 69
MEAN AGE = 55 years (range = 16–76 years)
MALES: 7%, FEMALES: 93%
CURRENT TREATMENT: Other
KEY DISEASE CHARACTERISTICS: Unilateral upper or lower extremity lymphedema with or without a history of cancer diagnosis; of the 69 patients, 42 had upper extremity lymphedema and 27 had lower extremity edema; of the patients with cancer, 40 had a history of breast cancer, 9 had a history of endometial cancer, 3 had a history of melanoma with lymphadenectomy, 2 a history of ovarian cancer, 2 had cervical cancer, 1 had sarcoma, and 1 had bladder cancer with lymphadenectomy; 9 patients had primary lymphedema, and 1 had traumatic lymphedema; of the patients with cancer, 39 had radiation therapy.
OTHER KEY SAMPLE CHARACTERISTICS: Patients with at least a one-year follow-up were included in the study.

Setting

SITE: Single site
SETTING TYPE: Not specified
LOCATION: Italy

Phase of Care and Clinical Applications

APPLICATIONS: Pediatrics, elder care

Study Design

Retrospective

Measurement Instruments/Methods

Measuring tape

Results

All patients lost volume with an average reduction of 50%. None of the study patients reported an event of cellulitis during the follow-up. Patients with histories of cellulitis had less reduction. A 49% reduction was seen in patients who had reported one to two events, and a 33% reduction was seen in those with more than two events.

Postoperative ICG: Three hundred thirty-seven of the 366 anastomosis remained patent.
Subjective reporting: Sixty-seven reported satisfaction: lighter limbs, softer tissue, less pain, and improved function.

Conclusions

The LVA appears to successfully establish alternate lymphatic drainage pathways in the lymph damaged limb. It is minimally invasive requiring considerably less surgery than the lymph node transplantation procedures and potentially better outcomes. The patients tolerate it well and recovery quickly. It is unclear whether patients no longer needed to use compression garments, but the study reported that all had a reduction in compression class. The researchers reported outcomes that did reflect disease progression: Stage IV limbs did not improve, as well as stage II.

Limitations

Small sample (< 100)
Risk of bias (no control group)
Risk of bias (no blinding)
Risk of bias (no random assignment)

Nursing Implications

The findings suggest that LVA may be helpful for patients to reduce lymphedema. Nurses need to be aware of patient education needs if this procedure is used.