Lympho-Venous Anastomosis in Early Stage Filarial Lymphedema

Filarial lymphedema (FLE) is the most common cause of secondary lymphedema, with endemic prevalence in developing countries. This has been traditionally managed conservatively with complex decongestive therapy (CDT) in early-stage and excisional surgery at late-stage. Results of Lympho-Venous Anastomosis (LVA) and post-oncological lymphedema have been encouraging, and it is currently a widely accepted surgical treatment. In this case report we demonstrate the planning and surgical steps along with the outcome of LVA in early-stage lower limb FLE. 32-year-old female with early-stage left lower limb FLE underwent two end-to-end lympho-venous anastomosis. Handheld ICG imaging was used to diagnose earlystage lymphedema and locate patent lymphatic channels for performing LVA. Patient showed decreased limb volume from 22% to 4% with the combined approach of Complex Decongestive Therapy (CDT) and LVA. At the 3-month follow-up, patient gave an excellent outcome on subjective scoring with a significant reduction in man hours spent in bandaging. Our early experience showed that LVA may represent an effective treatment option in the multi-modality approach to early-stage lower limb FLE.