A Prospective Study of the Impact of Lymphatic Venous Anastomosis as a Treatment for Lymphedema

Lymphedema is managed using conservative modalities, which are most effective in early stages. Surgical interventions, such as lymphaticovenous anastomosis (LVA), are becoming popular as a method to augment conservative modalities. Despite a growing body of evidence demonstrating surgical effectiveness, prospective studies using validated measures and patient-reported outcomes are needed to further evaluate the impact of LVA. This prospective study evaluated the effect of LVA on limb volume, quality of life, and psychosocial well-being. Adults with stage 1-2 lymphedema undergoing LVA between January 2020 and December 2023 were included. All participants underwent 2 weeks of preoperative bandaging followed by lymphaticovenous anastomoses. Postoperative bandaging was administered for 6 weeks. Excess limb volume, lymphedema-specific quality of life, generalized anxiety (Generalized Anxiety Disorder-7), depressive symptoms (Patient Health Questionnaire-8), and lymphedema symptom intensity and distress were measured preoperatively and 6 weeks postoperatively. Qualitative semistructured interviews were also undertaken to contextualize findings. Quantitative results indicated a modest reduction in percentage excess limb volume (median [interquartile range IQR], -4.40% [IQR, -12.20% to -1.50%], P = 0.0015). There were no significant differences in psychosocial well-being scores relative to baseline. Significant improvements in overall quality of life scores were noted (lymphedema-specific quality of life median [IQR], 2.00 [IQR, 1.00-3.00], P = 0.0022). Qualitative findings suggested improvements in physical, functional, and psychosocial domains. Our findings indicated modest improvements in percentage excess limb volume and overall quality of life after LVA. We therefore outlined several practice recommendations for the surgical care of lymphedema to improve surgical and postoperative management.