Semin Plast Surg 2018; 32(01): 022-027
DOI: 10.1055/s-0038-1636510
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Lymphovenous Anastomosis Bypass Surgery

Edward I. Chang
1   Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
,
Roman J. Skoracki
2   Department of Plastic Surgery, Ohio State University, Columbus, Ohio
,
David W. Chang
3   Section of Plastic Surgery, Department of Surgery, University of Chicago, Chicago, Illinois
› Author Affiliations
Further Information

Publication History

Publication Date:
09 April 2018 (online)

Abstract

The field of lymphedema surgery has witnessed tremendous advancements over the years and has been coupled to the rapid growth of supermicrosurgical techniques. A lymphovenous bypass or lymphaticovenular anastomosis is a new technique that requires identification of patent, residual lymphatic channels and performing an anastomosis to a recipient venule, thereby allowing outflow of lymphatic fluid and improvement in a patient's lymphedema. This article provides a summary of the maturation of the technique, as well as the technical aspects of the approach and the current outcomes in the treatment of postmastectomy lymphedema.

 
  • References

  • 1 Erdogan Iyigun Z, Duymaz T, Ilgun AS. , et al. Preoperative lymphedema-related risk factors in early-stage breast cancer. Lymphat Res Biol 2017; ( e-pub ahead of print)
  • 2 Card A, Crosby MA, Liu J, Lindstrom WA, Lucci A, Chang DW. Reduced incidence of breast cancer-related lymphedema following mastectomy and breast reconstruction versus mastectomy alone. Plast Reconstr Surg 2012; 130 (06) 1169-1178
  • 3 De Groef A, Van Kampen M, Tieto E. , et al. Arm lymphoedema and upper limb impairments in sentinel node-negative breast cancer patients: a one year follow-up study. Breast 2016; 29: 102-108
  • 4 Voss RK, Cromwell KD, Chiang YJ. , et al. The long-term risk of upper-extremity lymphedema is two-fold higher in breast cancer patients than in melanoma patients. J Surg Oncol 2015; 112 (08) 834-840
  • 5 Boughey JC, Hoskin TL, Cheville AL. , et al. Risk factors associated with breast lymphedema. Ann Surg Oncol 2014; 21 (04) 1202-1208
  • 6 DiSipio T, Rye S, Newman B, Hayes S. Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis. Lancet Oncol 2013; 14 (06) 500-515
  • 7 McLaughlin SA, Bagaria S, Gibson T. , et al. Trends in risk reduction practices for the prevention of lymphedema in the first 12 months after breast cancer surgery. J Am Coll Surg 2013; 216 (03) 380-389 , quiz 511–513
  • 8 Garza III R, Skoracki R, Hock K, Povoski SP. A comprehensive overview on the surgical management of secondary lymphedema of the upper and lower extremities related to prior oncologic therapies. BMC Cancer 2017; 17 (01) 468
  • 9 Carl HM, Walia G, Bello R. , et al. Systematic review of the surgical treatment of extremity lymphedema. J Reconstr Microsurg 2017; 33 (06) 412-425
  • 10 Nielubowicz J, Olszewski W. Experimental lymphovenous anastomosis. Br J Surg 1968; 55 (06) 449-451
  • 11 Chang DW, Masia J, Garza III R, Skoracki R, Neligan PC. Lymphedema: surgical and medical therapy. Plast Reconstr Surg 2016; 138 (3, Suppl): 209S-218S
  • 12 Silva AK, Chang DW. Vascularized lymph node transfer and lymphovenous bypass: novel treatment strategies for symptomatic lymphedema. J Surg Oncol 2016; 113 (08) 932-939
  • 13 Suami H, Chang DW. Overview of surgical treatments for breast cancer-related lymphedema. Plast Reconstr Surg 2010; 126 (06) 1853-1863
  • 14 Kung TA, Champaneria MC, Maki JH, Neligan PC. Current concepts in the surgical management of lymphedema. Plast Reconstr Surg 2017; 139 (04) 1003e-1013e
  • 15 Suami H, Chang DW, Yamada K, Kimata Y. Use of indocyanine green fluorescent lymphography for evaluating dynamic lymphatic status. Plast Reconstr Surg 2011; 127 (03) 74e-76e
  • 16 Burnier P, Niddam J, Bosc R, Hersant B, Meningaud JP. Indocyanine green applications in plastic surgery: a review of the literature. J Plast Reconstr Aesthet Surg 2017; 70 (06) 814-827
  • 17 Narushima M, Yamamoto T, Ogata F, Yoshimatsu H, Mihara M, Koshima I. Indocyanine green lymphography findings in limb lymphedema. J Reconstr Microsurg 2016; 32 (01) 72-79
  • 18 Yamamoto T, Narushima M, Yoshimatsu H. , et al. Dynamic indocyanine green (ICG) lymphography for breast cancer-related arm lymphedema. Ann Plast Surg 2014; 73 (06) 706-709
  • 19 Hara H, Mihara M, Seki Y, Todokoro T, Iida T, Koshima I. Comparison of indocyanine green lymphographic findings with the conditions of collecting lymphatic vessels of limbs in patients with lymphedema. Plast Reconstr Surg 2013; 132 (06) 1612-1618
  • 20 Akita S, Ogata F, Manabe I. , et al. Noninvasive screening test for detecting early stage lymphedema using follow-up computed tomography imaging after cancer treatment and results of treatment with lymphaticovenular anastomosis. Microsurgery 2017; 37 (08) 910-916
  • 21 Visconti G, Yamamoto T, Hayashi N, Hayashi A. Ultrasound-assisted lymphaticovenular anastomosis for the treatment of peripheral lymphedema. Plast Reconstr Surg 2017; 139 (06) 1380e-1381e
  • 22 Maclellan RA, Zurakowski D, Voss S, Greene AK. Correlation between lymphedema disease severity and lymphoscintigraphic findings: a clinical-radiologic study. J Am Coll Surg 2017; 225 (03) 366-370
  • 23 Mihara M, Hara H, Araki J. , et al. Indocyanine green (ICG) lymphography is superior to lymphoscintigraphy for diagnostic imaging of early lymphedema of the upper limbs. PLoS One 2012; 7 (06) e38182
  • 24 Hayashi A, Hayashi N, Yoshimatsu H, Yamamoto T. Effective and efficient lymphaticovenular anastomosis using preoperative ultrasound detection technique of lymphatic vessels in lower extremity lymphedema. J Surg Oncol 2017; ( e-pub ahead of print)
  • 25 Mihara M, Hara H, Kawakami Y. , et al. Multi-site lymphatic venous anastomosis using echography to detect suitable subcutaneous vein in severe lymphedema patients. J Plast Reconstr Aesthet Surg 2017; (e-pub ahead of print)
  • 26 Scaglioni MF, Fontein DBY, Arvanitakis M, Giovanoli P. Systematic review of lymphovenous anastomosis (LVA) for the treatment of lymphedema. Microsurgery 2017; 37 (08) 947-953
  • 27 Ito R, Wu CT, Lin MC, Cheng MH. Successful treatment of early-stage lower extremity lymphedema with side-to-end lymphovenous anastomosis with indocyanine green lymphography assisted. Microsurgery 2016; 36 (04) 310-315
  • 28 Loh CY, Wu JC, Nguyen A. , et al. The 5th world symposium for lymphedema surgery-recent updates in lymphedema surgery and setting up of a global knowledge exchange platform. J Surg Oncol 2017; 115 (01) 6-12
  • 29 Park JE, Chang DW. Advances and innovations in microsurgery. Plast Reconstr Surg 2016; 138 (05) 915e-924e
  • 30 Chang EI. My first 100 consecutive microvascular free flaps: pearls and lessons learned in first year of practice. Plast Reconstr Surg Glob Open 2013; 1 (04) e27
  • 31 Baltzer HL, Winocour S, Harless C, Saint-Cyr M. Lymphaticovenous bypass: adaptations and lessons learned. Plast Reconstr Surg Glob Open 2017; 5 (06) e1328
  • 32 Yoshimatsu H, Yamamoto T, Narushima M, Iida T, Koshima I. The guide wire method: a new technique for easier side-to-end lymphaticovenular anastomosis. Ann Plast Surg 2014; 73 (02) 231-233
  • 33 Narushima M, Mihara M, Yamamoto Y, Iida T, Koshima I, Mundinger GS. The intravascular stenting method for treatment of extremity lymphedema with multiconfiguration lymphaticovenous anastomoses. Plast Reconstr Surg 2010; 125 (03) 935-943
  • 34 Yamamoto T, Yoshimatsu H, Yamamoto N, Narushima M, Iida T, Koshima I. Side-to-end lymphaticovenular anastomosis through temporary lymphatic expansion. PLoS One 2013; 8 (03) e59523
  • 35 Yamamoto T, Chen WF, Yamamoto N, Yoshimatsu H, Tashiro K, Koshima I. Technical simplification of the supermicrosurgical side-to-end lymphaticovenular anastomosis using the parachute technique. Microsurgery 2015; 35 (02) 129-134
  • 36 Mihara M, Hara H, Iida T. , et al. Antegrade and retrograde lymphatico-venous anastomosis for cancer-related lymphedema with lymphatic valve dysfuction and lymphatic varix. Microsurgery 2012; 32 (07) 580-584
  • 37 Chen WF, Yamamoto T, Fisher M, Liao J, Carr J. The “octopus” lymphaticovenular anastomosis: evolving beyond the standard supermicrosurgical technique. J Reconstr Microsurg 2015; 31 (06) 450-457
  • 38 Campisi CC, Ryan M, Boccardo F, Campisi C. A single-site technique of multiple lymphatic-venous anastomoses for the treatment of peripheral lymphedema: long-term clinical outcome. J Reconstr Microsurg 2016; 32 (01) 42-49
  • 39 Koshima I, Inagawa K, Urushibara K, Moriguchi T. Supermicrosurgical lymphaticovenular anastomosis for the treatment of lymphedema in the upper extremities. J Reconstr Microsurg 2000; 16 (06) 437-442
  • 40 Chang DW. Lymphaticovenular bypass for lymphedema management in breast cancer patients: a prospective study. Plast Reconstr Surg 2010; 126 (03) 752-758
  • 41 Yamamoto T, Yamamoto N, Doi K. , et al. Indocyanine green-enhanced lymphography for upper extremity lymphedema: a novel severity staging system using dermal backflow patterns. Plast Reconstr Surg 2011; 128 (04) 941-947
  • 42 Chang DW, Suami H, Skoracki R. A prospective analysis of 100 consecutive lymphovenous bypass cases for treatment of extremity lymphedema. Plast Reconstr Surg 2013; 132 (05) 1305-1314
  • 43 Mihara M, Murai N, Hayashi Y. , et al. Using indocyanine green fluorescent lymphography and lymphatic-venous anastomosis for cancer-related lymphedema. Ann Vasc Surg 2012; 26 (02) 278.e1-278.e6
  • 44 Mihara M, Hara H, Hayashi Y. , et al. Upper-limb lymphedema treated aesthetically with lymphaticovenous anastomosis using indocyanine green lymphography and noncontact vein visualization. J Reconstr Microsurg 2012; 28 (05) 327-332
  • 45 Yamamoto T, Yamamoto N, Hayashi A, Koshima I. Supermicrosurgical deep lymphatic vessel-to-venous anastomosis for a breast cancer-related arm lymphedema with severe sclerosis of superficial lymphatic vessels. Microsurgery 2017; 37 (02) 156-159
  • 46 Winters H, Tielemans HJP, Hameeteman M. , et al. The efficacy of lymphaticovenular anastomosis in breast cancer-related lymphedema. Breast Cancer Res Treat 2017; 165 (02) 321-327
  • 47 Tourani SS, Taylor GI, Ashton MW. Long-term patency of lymphovenous anastomoses: a systematic review. Plast Reconstr Surg 2016; 138 (02) 492-498
  • 48 Lee KT, Park JW, Mun GH. Serial two-year follow-up after lymphaticovenular anastomosis for the treatment of lymphedema. Microsurgery 2017; 37 (07) 763-770
  • 49 Chen WF, Zhao H, Yamamoto T, Hara H, Ding J. Indocyanine green lymphographic evidence of surgical efficacy following microsurgical and supermicrosurgical lymphedema reconstructions. J Reconstr Microsurg 2016; 32 (09) 688-698
  • 50 Yamamoto T, Yamamoto N, Azuma S. , et al. Near-infrared illumination system-integrated microscope for supermicrosurgical lymphaticovenular anastomosis. Microsurgery 2014; 34 (01) 23-27
  • 51 Masia J, Olivares L, Koshima I. , et al. Barcelona consensus on supermicrosurgery. J Reconstr Microsurg 2014; 30 (01) 53-58
  • 52 Cornelissen AJM, Kool M, Lopez Penha TR. , et al. Lymphatico-venous anastomosis as treatment for breast cancer-related lymphedema: a prospective study on quality of life. Breast Cancer Res Treat 2017; 163 (02) 281-286
  • 53 Asdourian MS, Skolny MN, Brunelle C, Seward CE, Salama L, Taghian AG. Precautions for breast cancer-related lymphoedema: risk from air travel, ipsilateral arm blood pressure measurements, skin puncture, extreme temperatures, and cellulitis. Lancet Oncol 2016; 17 (09) e392-e405
  • 54 Jørgensen MG, Toyserkani NM, Sørensen JA. The effect of prophylactic lymphovenous anastomosis and shunts for preventing cancer-related lymphedema: a systematic review and meta-analysis. Microsurgery 2017; ( e-pub ahead of print)
  • 55 Yamamoto T, Yamamoto N, Yamashita M, Furuya M, Hayashi A, Koshima I. Efferent lymphatic vessel anastomosis: supermicrosurgical efferent lymphatic vessel-to-venous anastomosis for the prophylactic treatment of subclinical lymphedema. Ann Plast Surg 2016; 76 (04) 424-427
  • 56 Boccardo FM, Casabona F, Friedman D. , et al. Surgical prevention of arm lymphedema after breast cancer treatment. Ann Surg Oncol 2011; 18 (09) 2500-2505
  • 57 Boccardo F, Casabona F, De Cian F. , et al. Lymphedema microsurgical preventive healing approach: a new technique for primary prevention of arm lymphedema after mastectomy. Ann Surg Oncol 2009; 16 (03) 703-708
  • 58 Boccardo F, Casabona F, De Cian F. , et al. Lymphatic microsurgical preventing healing approach (LYMPHA) for primary surgical prevention of breast cancer-related lymphedema: over 4 years follow-up. Microsurgery 2014; 34 (06) 421-424