Skip to main content

Advertisement

Log in

Treatment of lymphedema with lymphaticovenular anastomoses

  • REVIEW ARTICLE
  • Published:
International Journal of Clinical Oncology Aims and scope Submit manuscript

Abstract

Although lymphedema in the extremities is a troublesome adverse effect following radical resection of various cancers, conventional therapies for lymphedema are not always satisfactory, and new breakthroughs are anticipated. With the introduction of supermicrosurgical techniques for the anastomosis of blood or lymphatic vessels less than 0.8 mm in diameter, we have developed a novel method of lymphaticovenular anastomosis for the treatment of primary as well as secondary lymphedema in the extremities. Here, we review the pathophysiological aspects of lymphedema, emphasizing the importance of smooth-muscle cell function in the affected lymphatic walls. We then describe the theoretical basis and detailed operative techniques of our lymphaticovenular anastomoses. Although technically demanding, especially for beginners, we believe that this method will become a new clinical standard for the treatment of lymphedema in the near future.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. N Thompson (1970) ArticleTitleBuried dermal flap operation for chronic lymphedema of the extremities. Ten-year survey of results in 79 cases Plast Reconstr Surg 45 541–548 Occurrence Handle4910556

    PubMed  Google Scholar 

  2. I Koshima Y Nanba T Tsutsui et al. (2003) ArticleTitleMedial plantar perforator flaps with supermicrosurgery Clin Plast Surg 30 447–455 Occurrence Handle10.1016/S0094-1298(03)00044-0 Occurrence Handle12916599

    Article  PubMed  Google Scholar 

  3. I Koshima K Inagawa K Etoh et al. (1999) ArticleTitleSupramicrosurgical lymphaticovenular anastomosis for the treatment of lymphedema in the extremities (in Japanese) Nippon Geka Gakkai Zasshi (Journal of Japan Surgical Society) 100 551–556

    Google Scholar 

  4. I Koshima K Inagawa K Urushibara et al. (2000) ArticleTitleSupermicrosurgical lymphaticovenular anastomosis for the treatment of lymphedema in the upper extremities J Reconstr Miscrosurg 16 437–442

    Google Scholar 

  5. I Koshima Y Nanba T Tsutsui et al. (2003) ArticleTitleLong-term follow-up after lymphaticovenular anastomosis for lymphedema in the leg J Reconstr Microsurg 19 209–215 Occurrence Handle10.1055/s-2003-40575 Occurrence Handle12858242

    Article  PubMed  Google Scholar 

  6. I Koshima Y Nanba T Tsutsui et al. (2004) ArticleTitleMinimal invasive lymphaticovenular anastomosis under local anesthesia for leg lymphedema: is it effective for stage III and IV? Ann Plast Surg 53 261–266 Occurrence Handle10.1097/01.sap.0000120319.89926.07 Occurrence Handle15480014

    Article  PubMed  Google Scholar 

  7. I Koshima T Higashino N Fukuda et al. (2005) ArticleTitleFunctional and structural characteristics of lymphatic systems and lymphedema (in Japanese) Ensho to Men-eki (Inflammatology and Immunology) 13 426–431

    Google Scholar 

  8. G Oliver (2004) ArticleTitleLymphatic vasculature development Nat Rev Immunol 4 35–45 Occurrence Handle10.1038/nri1258 Occurrence Handle14704766

    Article  PubMed  Google Scholar 

  9. MJ Karkkainen A Saaristo L Jussila et al. (2001) ArticleTitleA model for gene therapy of human hereditary lymphedema Proc Natl Acad Sci U S A 98 12 677–12 682 Occurrence Handle10.1073/pnas.221449198

    Article  Google Scholar 

  10. RE Ferrell (2002) ArticleTitleResearch perspectives in inherited lymphatic disease Ann N Y Acad Sci 979 39–51 Occurrence Handle12543715

    PubMed  Google Scholar 

  11. SJ Mandriota L Jussila M Jeltsch et al. (2001) ArticleTitleVascular endothelial growth factor-C-mediated lymphangiogenesis promotes tumour metastasis EMBO J 20 672–682 Occurrence Handle10.1093/emboj/20.4.672 Occurrence Handle11179212

    Article  PubMed  Google Scholar 

  12. M Skobe T Hawighorst DG Jackson et al. (2001) ArticleTitleInduction of tumor lymphangiogenesis by VEGF-C promotes breast cancer metastasis Nat Med 7 192–198 Occurrence Handle10.1038/84643 Occurrence Handle11175850

    Article  PubMed  Google Scholar 

  13. JT Wigle N Harvey M Detmar et al. (2002) ArticleTitleAn essential role for Prox1 in the induction of the lymphatic endothelial cell phenotype EMBO J 21 1505–1513 Occurrence Handle10.1093/emboj/21.7.1505 Occurrence Handle11927535

    Article  PubMed  Google Scholar 

  14. M Földi (1984) Lymphedema NC Straub PS Mortimer (Eds) Edema Raven New York

    Google Scholar 

  15. I Koshima S Kawada T Moriguchi et al. (1996) ArticleTitleUltrastructural observations of lymphatic vessels in lymphedema in human extremities Plast Reconstr Surg 97 397–405 Occurrence Handle8559823

    PubMed  Google Scholar 

  16. C Campisi F Boccardo A Zilli et al. (2001) ArticleTitleLong-term results after lymphatic-venous anastomoses for the treatment of obstructive lymphedema Microsurgery 21 135–139 Occurrence Handle10.1002/micr.1025 Occurrence Handle11494379

    Article  PubMed  Google Scholar 

  17. BM O'Brien WA Morrison (1987) Microlymphatic surgery, reconstructive microsurgery Churchill-Livingstone Edinburgh 485–505

    Google Scholar 

  18. DG Bichet (1992) Renal sodium excretion, edematous disorders, and diuretic use RW Schrier (Eds) Renal and electrolyte disorders Little, Brown and Company Boston

    Google Scholar 

  19. I Koshima K Inagawa K Urushibara et al. (1998) ArticleTitleEtiology and symptoms of 35 cases with lymphedema in lower extremity: transition from unilateral into bilateral lymphedema (in Japanese) Nippon Keiseigeka Gakkai Zasshi (Journal of Japan Society of Plastic and Reconstructive Surgery) 18 138–143

    Google Scholar 

  20. L Clodius (1990) Lymphedema JG McCarthy (Eds) Plastic surgery, vol. 6. The trunk and lower extremity Saunders Philadelphia 4093–4101

    Google Scholar 

  21. JB Kinmonth PA Hurst JM Edwards et al. (1978) ArticleTitleRelief of lymph obstruction by use of a bridge of mesentery and ileum Br J Surg 65 829–833 Occurrence Handle737415

    PubMed  Google Scholar 

  22. BM O'Brien LA Chait PJ Hurwitz (1977) ArticleTitleMicrolymphatic surgery Orthop Clin North Am 8 405–424 Occurrence Handle896169

    PubMed  Google Scholar 

  23. BM O'Brien CG Mellow RK Khazanchi et al. (1990) ArticleTitleLong-term results after microlymphaticovenous anastomoses for the treatment of obstructive lymphedema Plast Reconstr Surg 85 562–572 Occurrence Handle2315396

    PubMed  Google Scholar 

  24. RG Baumeister S Siuda (1990) ArticleTitleTreatment of lymphedemas by microsurgical lymphatic grafting: what is proved? Plast Reconstr Surg 85 64–74 Occurrence Handle2293739

    PubMed  Google Scholar 

  25. RG Baumeister S Siuda H Bohmert et al. (1986) ArticleTitleA microsurgical method for reconstruction of interrupted lymphatic pathways: autologous lymph-vessel transplantation for treatment of lymphedemas Scand J Plast Reconstr Surg 20 141–146 Occurrence Handle3775285

    PubMed  Google Scholar 

  26. YS Yoon T Murayama E Gravereaux et al. (2003) ArticleTitleVEGF-C gene therapy augments postnatal lymphangiogenesis and ameliorates secondary lymphedema J Clin Invest 111 717–725 Occurrence Handle10.1172/JCI200315830 Occurrence Handle12618526

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Isao Koshima.

About this article

Cite this article

Nagase, T., Gonda, K., Inoue, K. et al. Treatment of lymphedema with lymphaticovenular anastomoses. Int J Clin Oncol 10, 304–310 (2005). https://doi.org/10.1007/s10147-005-0518-5

Download citation

  • Received:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10147-005-0518-5

Key words

Navigation