Indication of Lymphaticovenous Anastomosis for Lower Limb Primary Lymphedema

Background: Lymphedema can be classified as either primary or secondary. In the present study, the authors investigated the efficacy of lymphaticovenous anastomosis for correcting primary lower limb lymphedema and to determine its indications and contraindications. Methods: The authors retrospectively examined patients with primary lower limb lymphedema who underwent lymphaticovenous anastomosis between April of 2009 and September of 2013. Anastomosis efficacy was evaluated using lower limb circumference measurements at five anatomical locations. Lymphedema staging was determined using modified leg dermal backflow stage. The authors added two categories to the standard leg dermal backflow staging system: no backflow and distal backflow. Lymphaticovenous anastomosis was performed under local anesthesia, except in pediatric cases. Results: The authors evaluated 62 patients (79 lower limbs). Lower limb circumference increased after lymphaticovenous anastomosis in patients with an onset age of 1 year or later and before age 11 years, but it significantly decreased in patients with an onset age older than 11 years. The presence of lymphedema for a longer period did not negatively impact lymphaticovenous anastomosis efficacy. In particular, lymphaticovenous anastomosis was effective in the leg dermal backflow stage 2 and no backflow group. Conclusions: For patients developing lymphedema before 11 years of age, the indications should be considered carefully. However, lymphaticovenous anastomosis was effective in patients developing lymphedema after the age of 11 years. Regardless, due to its low level of invasiveness, lymphaticovenous anastomosis may be considered for patients who are refractory to conservative treatment, even if they have early-onset lymphedema. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.