Short- and Long-term Patency of Prophylactic and Therapeutic Lymphovenous Anastomosis for Extremity Lymphedema: A Systematic Review.

BACKGROUND

The clinical effectiveness of lymphovenous anastomosis (LVA) for extremity lymphedema often decreases after 6-12 months. This waning effect is believed to be associated with loss of anastomotic patency, but patency rates remain poorly defined in the current literature. Consequently, the goal of this systematic review is to summarize the available evidence on short- (≤12 mo) and long-term (>12 mo) patency following supermicrosurgical LVA.

METHODS

A preferred reporting items for systematic reviews and meta-analyses-compliant systematic literature search for lymphedema, LVA, and patency/imaging was conducted in Embase, Medline (Ovid), and Web of Science. Citation searching via Lens.org, Scopus, and Web of Science supplemented the primary search. Risk of bias was assessed using ROBINS-I and RoB-2.0 tools. Study results were tabulated and summarized narratively.

RESULTS

A total of 2011 records were screened, of which twelve observational studies and one randomized controlled trial (1089 patients) met the inclusion criteria. Short-term patency after therapeutic LVA ranged from 32% to 93% and long-term patency from 36% to 97%. Prophylactic LVA demonstrated comparable durability with a patency rate of 80% after 18 months. Importantly, studies utilizing indocyanine green lymphography consistently reported lower short-term patency rates than those using lymphoscintigraphy. The majority of studies exhibited serious risk of bias.

CONCLUSIONS

Long-term patency after LVA appears achievable in a substantial proportion of patients with extremity lymphedema. However, the marked variability in reported patency rates, serious risk of bias, and heterogeneity in imaging methods and patency definitions highlights the need for standardized postoperative patency assessment.