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100 Consecutive Lymphovenous Bypass for Treatment Of Upper Extremity Lymphedema: What Have We Learned?
David W. Chang, MD, Hiroo Suami, MD., PhD, Roman Skoracki, MD.
MD Anderson Cancer Center, HOUSTON, TX, USA.

ABSTRACT
Background: The purpose of our study was to evaluate whether lymphovenous bypass is effective in treating patients with lymphedema.
Methods: 100 consecutive patients with lymphedema of upper extremity secondary to treatment of breast cancer were prospectively enrolled in this study. In 70 patients, ICG fluorescent lymphography was used to aid in lymphovenous bypass operation. Evaluation included qualitative assessment and quantitative volumetric analysis prior to surgery and at 3 months, 6 months, and 1 year following the procedure.
Results: The mean lymphedema duration was 3.5 years. The mean body mass index was 30. The mean preoperative volume differential between the lymphedematous arms and unaffected arms was 32%. The mean number of bypasses performed per patient was 6. Symptom improvement was reported by 96% of patients. Quantitative improvement based on postoperative volume measurements was noted in 74% of the patients. The overall mean volume differential reduction was 33% at 3 months, 36% at 6 months, and 42% at 12 months after surgery (Fig. 1). However, patients with stage 1 or 2 lymphedema had significantly larger mean volume differential reduction than patients with stage 3 or 4 lymphedema: 58% versus 12% at 3 months, 52% versus 16% at 6 months, and 61% versus 17% at 1 year (Fig. 2).
Conclusion: Lymphovenous bypass can be effective in treating patients with lymphedema, particularly for early and less severe lymphedema. The use of ICG lymphangiography is helpful in facilitating lymphovenous bypass by accurately identifying functional lymphatic vessels and may also be useful in objectively assessing the status of the lymphedema and in patient selection.
Figure 1. Mean volume differential reduction over time
Figure 2. Lymphedema classification based on ICG lymphangiography findings.


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