Application of venous lymph node transplantation combined with LVA for the treatment of secondary upper limb lymphedema&nbsp;&nbsp;

doi:10.13418/j.issn.1001-165x.2025.2.03

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Chinese Journal of Clinical Anatomy ›› 2025, Vol. 43 ›› Issue (2) : 133-137. DOI: 10.13418/j.issn.1001-165x.2025.2.03

Application of venous lymph node transplantation combined with LVA for the treatment of secondary upper limb lymphedema

Wu Jianlong¹, Xie Qingping², Zhu Ziguan¹, Lu Hongrui¹, Chen Boda¹, Yang Xiaodong¹

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Abstract

Objective To explore the surgical method and clinical efficacy of venous lymph node transplantation (VLNT) combined with lymphatic vein anastomosis (LVA) for the treatment of secondary upper limb lymphedema. Methods From August 2021 to June 2024, our hospital treated 16 patients with secondary upper limb lymphedema using venous lymph node transplantation (VLNT) combined with LVA. All patients underwent preoperative measurements of the circumference of both upper limb arms, with measurements taken every 5cm from the wrist to the axilla, and data was recorded. All patients underwent high-frequency color Doppler ultrasound lymphatic examination and indocyanine green (ICG) near-infrared lymphatic imaging examination before surgery to locate and mark functional lymphatic vessels in the limbs and lymphatic obstruction areas in the axilla. The inguinal lymph node tissue flap (3-4 lymph nodes) containing superficial venous vessels were cut and transplanted to the axilla of the affected limb for flow-through anastomosis of the superficial vein and recipient vein. Based on preoperative lymphatic vessel localization, a small longitudinal incision (2-3 cm) was made to cut through the skin to the fat layer, and functional lymphatic vessels were selected for anastomosis with subcutaneous veins under a microscope. The circumference of the upper limb arm of the affected limb after surgery was measured and recorded using the same method. Results All 16 patients had unilateral upper limb lymphedema, aged 52-78 years old. All patient incisions healed well. The follow-up period was 6-24 months (average 12 months), and the edema of the affected limb was significantly reduced before surgery. The measured circumference of the affected limb in different planes was significantly reduced compared to before surgery (P<0.05). The upper limb activity function has improved compared to before surgery, and the patient was satisfied with the recovery. Conclusions The combination of venous lymph node transplantation and LVA treatment for secondary upper limb lymphedema can significantly reduce limb edema, improve patient's limb function, and achieve satisfactory therapeutic effects.

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Lymphedema / / / / Venous lymph nodes transplantation / / / / Lymphatic vein anastomosis

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Wu Jianlong, Xie Qingping, Zhu Ziguan, Lu Hongrui, Chen Boda, Yang Xiaodong. Application of venous lymph node transplantation combined with LVA for the treatment of secondary upper limb lymphedema [J]. Chinese Journal of Clinical Anatomy. 2025, 43(2): 133-137 https://doi.org/10.13418/j.issn.1001-165x.2025.2.03

References

[1] Liang M, Chen Q, Peng K, et al. Manual lymphatic drainage for lymphedema in patients after breast cancer surgery: A systematic review and meta-analysis of randomized controlled trials[J]. Medicine (Baltimore),2020, 99(49):e23192. DOI: 10.1097/MD.00000000000 23192.
[2] 袁芊芊, 侯晋轩, 苏科华, 等. 基于上肢淋巴引流的乳腺癌术后水肿风险因素分析[J].中华普通外科杂志, 2021, 36(8):579-584. DOI: 10.3760/cma.j.cn113855-20210203-00084.
[3] 宋达疆, 彭文, 李赞, 等. 携带髂腹股沟淋巴组织瓣的游离腹壁下动脉穿支皮瓣治疗乳腺癌根治术后并发上肢淋巴水肿并再造乳房的临床效果[J]. 中华烧伤与创面修复杂志, 2019, 35(4): 277-283. DOI: 10.3760/cma.j.issn.1009-2587.2019.04.007.
[4] Paramanandam VS, Dylke E, Clark GM, et al. Prophylactic use of compression sleeves reduces the incidence of arm swelling in women at high risk of breast cancer-related lymphedema: a randomized controlled trial[J]. J Clin Oncol, 2022,40(18):2004-2012. DOI: 10.1200/JCO.21. 02567.
[5] 林武华, 陈茜, 周琦. 乳腺癌术后上肢淋巴水肿的危险因素分析[J].中华乳腺病杂志(电子版), 2020, 14(3):141-141. DOI: 10. 3877 /cma. j. issn. 1674-0807. 2020. 03. 003.
[6] 兰荣玉, 张卫华, 韩林轩, 等. 血管化淋巴结移植联合淋巴静脉吻合术治疗乳腺癌术后淋巴水肿的效果观察[J].中华整形外科杂志, 2023, 39(11):1183-1191. DOI: 10.3760/cma.j.cn114453-20230628-00139.
[7] Scaglioni MF, Meroni M, Fritsche E. Lymphaticovenous anastomosis (LVA) for breast cancer-related lymphedema treatment[J]. Transl Cancer Res, 2020, 9(5):3167-3171. DOI: 10.21037/tcr.2020.04.14.
[8] Schaverien MV, Hofstetter WL, Hall MS, et al. Jejunal mesenteric venous lymph node transplantation for lymphedema: outcomes and technical modifications[J]. Plast Reconstr Surg, 2022, 149(4):700e-710e. DOI: 10.1097/PRS.0000000000008960.
[9] McLaughlin SA, Brunelle CL, Taghian A. Breast cancer-related lymphedema: risk factors, screening, management, and the impact of locoregional treatment[J]. J Clin Oncol, 2020, 38(20):2341-2350. DOI: 10.1200/JCO.19.02896.
[10] 王成龙, 栾杰, 穆大力, 等. 乳腺癌术后上肢淋巴水肿的治疗进展[J].中华整形外科杂志,2018, 34(7):578-578. DOI: 10.3760/cma.j.issn. 1009-4598.2018.07.021.
[11]Donahue PMC, MacKenzie A, Filipovic A, et al. Advances in the prevention and treatment of breast cancer-related lymphedema[J]. Breast Cancer Res Treat, 2023, 200(1):1-14. DOI: 10.1007/s10549-023-06947-7.
[12]Shamoun S, Ahmad M. Complete decongestive therapy effect on breast cancer related to lymphedema: a Systemic review and meta-analysis of randomized controlled trials[J]. Asian Pac J Cancer Prev, 2023, 24(7):2225-2238. DOI: 10.31557/APJCP.2023.24.7.2225.
[13]舒晴, 胡艳, 栾春亮, 等. 体外冲击波治疗中重度乳腺癌相关淋巴水肿患者的疗效观察[J]. 中华物理医学与康复杂志, 2020, 42(2): 166-170. DOI: 10.3760/cma.j.issn.0254-1424.2020.02.018.
[14]Will PA, Wan Z, Seide SE, et al. Supermicrosurgical treatment for lymphedema: a systematic review and network meta-analysis protocol[J]. Syst Rev, 2022, 11(1):18. DOI: 10.1186/s13643-022-01885-9.
[15]汤靖岚, 孙立涛, 鲁科峰, 等. 超声造影在继发性上肢淋巴水肿术前规划中的应用价值研究[J]. 中华整形外科杂志, 2024, 40(7):755-764. DOI: 10.3760/cma.j.cn114453-20240131-00038.
[16] 陈林海, 杨专, 郑钧水, 等. 淋巴水肿影像诊断的研究进展[J]. 中华整形外科杂志, 2021, 37(04):446-446. DOI: 10.3760/cma.j.cn114453-20191226-00386.
[17]Kim HB, Jung SS, Cho MJ, et al. Comparative analysis of preoperative high frequency color Doppler ultrasound versus MR lymphangiography versus ICG lymphography of lymphatic vessels in lymphovenous anastomosis[J]. J Reconstr Microsurg, 2023,39(2): 92-101. DOI:10.1055/s-0042-1745745.
[18]张赟, 梁碧玲, 高立, 等. 磁共振弥散加权成像诊断颈部淋巴结的临床价值[J].中华肿瘤杂志, 2007, 29(01):70-73.
[19]Forte AJ, Boczar D, Huayllani MT, et al. Use of magnetic resonance imaging lymphangiography for preoperative planning in lymphedema surgery: A systematic review[J]. Microsurgery, 2021, 41(4):384-390. DOI: 10.1002/micr.30731.
[20] 韩涛, 季易, 邹继军, 等. 吲哚菁绿淋巴造影在儿童囊性淋巴管畸形诊断中的应用[J]. 中华整形外科杂志, 2021, 37(12):1333-1338. DOI: 10.3760/cma.j.cn114453-20200818-00474.
[21] Karakawa R, Yoshimatsu H, Tanakura K, et al. An anatomical study of the lymph-collecting vessels of the medial thigh and clinical applications of lymphatic vessels preserving profunda femoris artery perforator (LpPAP) flap using pre- and intraoperative indocyanine green (ICG) lymphography[J]. J Plast Reconstr Aesthet Surg, 2020, 73(9):1768-1774. DOI: 10.1016/j.bjps.2020.03.023.
[22] Yoshida S, Koshima I, Imai H, et al. Lymphaticovenous anastomosis for age-related lymphedema[J]. J Clin Med，2021, 10(21):5129. DOI: 10.3390/jcm10215129.
[23]Hara H, Mihara M. Multi-area lymphaticovenous anastomosis with multi-lymphosome injection in indocyanine green lymphography: A prospective study[J]. Microsurgery,2019, 39(2):167-173. DOI: 10.1002/micr. 30398.
[24]Hara H, Mihara M. Treating and preventing recurrence of recurrent genital acquired lymphangiectasia using lymphaticovenous anastomosis at genital area: A case report[J]. Microsurgery, 2020, 40(3):399-403. DOI: 10.1002/micr.30552.
[25]Cheng MH, Tee R, Chen C, et al. Simultaneous ipsilateral venous lymph node transplantation and contralateral lymphovenous anastomosis in bilateral extremity lymphedema with different severities[J]. Ann Surg Oncol, 2020, 27(13):5267-5276. DOI: 10.1245/s10434-020-08720-2.
[26]Gould DJ, Mehrara BJ, Neligan P, et al. Lymph node transplantation for the treatment of lymphedema[J]. J Surg Oncol, 2018 , 118(5):736-742. DOI: 10.1002/jso.25180.
[27]Schaverien MV, Asaad M, Selber JC, et al. Outcomes of Venous Lymph Node Transplantation for Treatment of Lymphedema[J]. J Am Coll Surg, 2021, 232(6):982-994. DOI: 10.1016/j.jamcollsurg. 2021. 03.002.
[28] Hassani C, Tran K, Palmer SL, et al. Venous lymph node transfer: a primer for the radiologist[J]. Radiographics, 2020, 40(4):1073-1089. DOI: 10.1148/rg.2020190118.