Outcomes for Combined VLNT and LVA in the Treatment of Lymphedema
Rebecca M. Garza, M.D., Joshua Falk, M.A., David W. Chang, M.D..
University of Chicago, Chicago, IL, USA.
Purpose: In the present study, we aim to challenge the paradigm of performing lymphovenous anastomosis (LVA) for less severe lymphedema and vascularized lymph node transfer (VLNT) for more advanced disease. Outcomes of combined VLNT + LVA for patients both in early and late stages of disease are assessed.
Methods: All patients who underwent combined VLNT + LVA for treatment of lymphedema over a 3-year period were evaluated. Preoperative characteristics, intraoperative details, and postoperative outcomes (limb volume reduction, Lymphedema Life Impact Scale [LLIS] score, subjective improvement) were assessed.
Results: 134 patients underwent combined VLNT + LVA for a total 268 procedures. Patients experienced an average 22.08% reduction in affected limb volume at 3 months (p<0.001), 15.11% at 6 months (p=0.02), and 18.21% at 1 year (p<0.001). LLIS scores were on average 15.22% lower (p<0.001) at 3 months postoperatively, 26.53% lower by 1 year (p<0.001), and 23.18% lower at 2 years (p=0.08). 84.17% of patients reported subjective improvement. Regression showed that male sex was significantly associated with volume reduction over time, while lower extremity lymphedema was inversely associated.
Conclusions: Volume reduction in the affected limb was observed at all time points postoperatively, with characteristic trend of greatest initial improvement, then rebound in edema, followed by gradual volume decrease over time. Patients experienced significant improvement in their functional status and self-reported limb quality. Combined VLNT + LVA is an appropriate and effective approach for both early and late stage disease in patients with either primary or secondary lymphedema.
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