Simultaneous Vascularized Lymph Node Transfer And Lymphovenous Anastomosis For Treatment Of Lymphedema
Rebecca M. Garza, MD1, Maureen Beederman, MD1, Shailesh Agarwal, MD2, Cedric Hunter, MD3, David W. Chang, MD1.
1University of Chicago, Chicago, IL, USA, 2Harvard Brigham and Women's Hospital, Boston, MA, USA, 3University of Tennessee, Memphis, TN, USA.
Purpose: We analyze the outcomes of simultaneous VLNT + LVA for treatment of primary and secondary lymphedema. To the best of our knowledge, this is the largest study to date with long-term outcome data of this novel approach.
Methods: 328 patients who underwent physiologic surgical treatment over a 5.5-year time period were evaluated using a prospective database and chart review. Preoperative characteristics, operative details, and postoperative outcomes (volume difference change, LLIS score) were assessed. Statistical analysis including multivariate regression was performed.
Results: 220 patients underwent simultaneous VLNT + LVA. Mean follow-up time was 14.81 months (range 0 - 57.87 months). The majority improved and experienced an average 28.14% reduction in limb volume difference at 3 months (p<0.01), 23.12% at 6 months (p=0.05), 21.42% at 1 year (p<0.01), 36.16% at 2 years (p=0.03), and 25.5% at 3 years (p=0.32). Improvements were most significant for patients with secondary upper limb, followed by secondary lower limb, and then primary lymphedema. LLIS scores were an average 6.87% lower (p<0.001) at 3 months and progressively improved over time to an average 27.2% lower at 3 years postoperatively (p<0.001).
Conclusions: Simultaneous VLNT + LVA is an appropriate and effective approach for both primary and secondary lymphedema with significant objective and subjective improvements. Volume reduction in the affected limb was observed at all time points postoperatively with significant improvement in LLIS scores.
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