The gold standard treatment with patients in reductive (phase 1) and maintenance (phase 2) phase is complex decongestive therapy. In addition, recent days, surgical treatment, especially micro-surgical treatment has been issued. Lymphaticovenous Anastomosis (LVA) involves the creation of connections between the lymphatic system and the venous system in the distal or proximal extremity. It has been concerned that supermicrosurgery (anastomosis less than 0.8 mm vessels) is used in this technique, in which lymphatic vessels and adjacent venules are anastomosed, mostly in an end-to-end fashion.
The purpose of this study was to assess the effectiveness of LVA in Patients with Lymphedema by using ultrasonography.
The study was retrospective study which included the data of 36 patients (man 1, women 35) with International Society of Lymphography stage 1 or 2 upper or lower extremity lymphedema (upper 18, lower 18), who underwent LVA between July of 2018 and February of 2019. All patients were examined at 4 point of period; pre-operation, follow up after surgery at 1week after operation, 4weeks after operation and 3months after operation. Several measurement were gathered with time flow, at same location : above 10cm and below 10cm of elbow or knee level of affected and unaffected side. Outcome measures were consisted with circumference and ultrasonographic findings, such as skin thickness, subcutaneous thickness and elastocity. Also, pre-operative, post-operative(4weeks after operation) evaluation of Lymphedema Qualitiy of Life(LYMQOL) and SF-36 test were done.
By using repeated measurements, the effect of time and operation(on lesion side) was evaluated with Mixed-linear model. For making a decision on final model of each measurement, Akalike Information Criterion was considered. For statistical analyses, SPSS Version 25.0 KO for Windows (SPSS Korea Data Solutions Inc, Seoul, South Korea) was utilized. For all tests, statistical significance was set at 0.05.
As a result, skin thickness above 10cm and subcutaneous thickness above 10cm of elbow and knee showed significance(P<0.05). Also, subcutaneous thickness below 10cm of elbow and knee showed borderline significance(P=0.067). In addition, there was a tendency of improvement in score of LYMQOL and SF-36 test.
The limitation of this study includes the followings. First, the ecruited amount of case was small, therefore, the statistical significance was too hard to get. Second, all patients data was not complete, so, e incomplete data was included on statistical analyses.
This study shows not only the effectiveness of LVA in patients with Lymphedema, but also the usefulness of utilizing ultrasonography on following up evaluation. Through LVA, the pressure maybe controlled, therefore, skin and subcutaneous thicknesses are decreased along the time. Further follow up study is needed for interpretation the progress of lymphedema. |
