Surgical treatment of lymphostasis. Literature review
https://doi.org/10.17238/2072-3180-2026-1-224-228
Abstract
Introduction. Secondary lymphostasis (lymphedema) is a consequence of impaired lymphatic drainage from the limb due to various causes. An increase in the incidence of breast cancer leads to an increase in severe lymphostasis requiring surgical correction. Erysipelas is traditionally distinguished among the causes of lymphostasis of the lower extremities, causing persistent lymphedema that does not respond to conservative therapy, as well as malignant diseases of the genital area in men. The increase in patients with lymphedema requiring surgical correction necessitates the search for new ways to restore patency of the lymphatic pathways.
Materials and methods. The search for literary sources was carried out in the PubMed and eLibrary databases.
The main part. New protocols for X-ray contrast studies with the search for new areas of lymph insertion and drainage are proposed. One of the most effective methods is fluorescence lymphography. Ultrasound is widely used to determine the condition of lymph nodes. The article discusses various methods of applying lymphovenous anastomoses, advantages and disadvantages, and the number of shunts applied. The issues of preventive lymphovenous bypass surgery and lymph node transplantation are discussed.
Conclusion. Lymphovenous anastomosis is the method of choice in the treatment of lymphedema. With the functioning of the shunt, patients note a subjective improvement, a significant decrease in the volume of the limb. Most studies confirm the effectiveness of this method in the long term. The issues of preventive lymphovenous anastomosis and lymph node transplantation require further consideration.
About the Authors
R. A. Pakhomova
ROSBIOTECH
Russian Federation
Russian Federation
Pakhomova Regina Alexandrovna – MD, Associate Professor, Head of the Department of Plastic Surgery
125080, 11 Volokolamsk Highway, Moscow
I. V. Kopytich
ROSBIOTECH
Russian Federation
Russian Federation
Kopytich Igor Viktorovich – a postgraduate student of the Department of Plastic Surgery
125080, 11 Volokolamsk Highway, Moscow
References
1. Cheng M.H., Chang D.W., Patel K.M. Principles and Practice of Lymphedema Surgery. Elsevier Health Sciences, 2015, 226 р.
2. Nemechkina A.O., Nikitina E.A., Tokaev V.K., Davydov D.V. Modern diagnosis of lymphedema. Plastic Surgery and Aesthetic Medicine, 2025, № 3–2, рр. 104–109. (In Russ.). https://doi.org/10.17116/plast.hirurgia2025032104
3. Gombert A., Heinzel A., Barbati M.E., Doukas P., Schmitt L., Shekarchian S., Winz O., Mottaghy F., Jalaie H. Assessment of the lymphatic system by indirect lymphography in patients with post-thrombotic syndrome. J Vasc Surg Venous Lymphat Disord., 2022, № 10(5), рр. 1072–1078. https://doi.org/10.1016/j.jvsv.2022.03.014
4. Lobastov K.V., Kaplina (Demekhova) M.Yu., Kononova Yu.A., Kozlova V.V., Shchastyantsev I.V. Phlebolymphedema: modern concepts and possibilities of correction. Phlebology, 2024, № 18(4), p.. 339–350. (In Russ.). https://doi.org/10.17116/flebo202418041339
5. Sevick-Muraca E.M., Fife C.E., Rasmussen J.C. Imaging peripheral lymphatic dysfunction in chronic conditions. Front Physiol., 2023, № 14, рр. 1132097. https://doi.org/10.3389/fphys.2023.1132097
6. Suami H., Thompson B., Mackie H., Blackwell R., Heydon-White A., Blake F.T., Boyages J., Koelmeyer L. A new indocyanine green fluorescence lymphography protocol for diagnostic assessment of lower limb lymphoedema. J Plast Reconstr Aesthet Surg., 2022, № 75(11), рр. 3946–3955. https://doi.org/10.1016/j.bjps.2022.08.017
7. Kaciulyte J., Garutti L., Spadoni D., Velazquez-Mujica J., Losco L., Ciudad P. et al. Genital Lymphedema and how to deal with it: pearls and pitfalls from over 38 years of experience with unusual lymphatic system impairment. Med (Kaunas)., 2021, № 57(11).
8. Garza R., Skoracki R., Hock K., Povoski S.P. A comprehensive overview on the surgical management of secondary lymphedema of the upper and lower extremities related to prior oncologic therapies. BMC Cancer, 2017, Jul 5; № 17(1), рр. 468. https://doi.org/10.1186/s12885-017-3444-9
9. Executive Committee of the International Society of Lymphology. The Diagnosis and Treatment of Peripheral Lymphedema: 2023 Consensus Document of The International Society of Lymphology. Lymphology, 2023, № 56(4), рр. 133–151.
10. Pomata C.D., Pons G., Masia J. Barcelona lymphedema algorithm for surgical treatment (BLAST). Ann Breast Surg., 2024, № 8, рр. 7.
11. Yamamoto T. et al. Side-to-end lymphaticovenular anastomosis through temporary lymphatic expansion. PLoS One, 2013, № 8(3), рр. e59523. https://doi.org/10.1371/journal.pone.0059523
12. Chizh E.Y. Formation of lymphovenous anastomoses in patients with secondary limb lymphedema. The results of a 5-year follow-up. Moscow Surgical Journal, 2018, № 3, рр. 152.
13. Depypere B., Vyncke T., Dhooghe N. et al. A novel technique for preventive lymphovenous anastomosis: anastomosing a ligated lymphatic Vessel. Plast Reconstr Surg Glob Open, 2021, № 9(3), рр. e3509.
14. Bytinger V.F., Kurochkina O.S. End-to-end and end-to-side lymphovenular anastomoses without vascular clips (retrospective analysis). Plastic surgery and aesthetic medicine, 2021, № 3, рр. 75–84. (In Russ.)
15. Yamamoto T., Yoshimatsu H., Yamamoto N., Yokoyama A., Tashiro K., Narushima M., Koshima I. Modified lambda-shaped lymphaticovenular anastomosis with supermicrosurgical lymphoplasty technique for a cancer-related lymphedema patient. Microsurgery, 2014, May; № 34(4), рр. 308–310. https://doi.org/10.1002/micr.22187
16. Zheng Y., Zhang S., Li J. et al. Overlapping lockup lymphaticovenous anastomosis: a useful addition to supermicrosurgery. J Vasc Surg Venous Lymphat Disord, 2024, № 12(1), рр. 101684.
17. Kojimahara T., Kageyama T. Octopus anastomosis: selection of anastomotic configuration in lymphaticovenular anastomosis according to vessels’ conditions. Breast Cancer Research and Treatment, 2021, № 186(1). https://doi.org/10.1007/s10549-021-06157-z
18. Onoda S., Satake T., Kinoshita M. Relationship Between Lymphaticovenular Anastomosis Outcomes and the Number and Types of Anastomoses. J Surg Res., 2022, Jan; № 269, рр. 103–109. https://doi.org/10.1016/j.jss.2021.08.012
19. Yang J.C., Wu S.C., Hayashi A. et al. Selection of optimal functional lymphatic vessel cutoff size in Supermicrosurgical Lymphaticovenous Anastomosis in Lower Extremity Lymphedema. Plast Reconstr Surg., 2022, № 149(1), рр. 237–246.
20. Jørgensen M.G., Toyserkani N.M., Sørensen J.A. The effect of prophylactic lymphovenous anastomosis and shunts for preventing cancer-related lymphedema: a systematic review and meta-analysis. Microsurgery, 2018, Jul; № 38(5), рр. 576–585. https://doi.org/10.1002/micr.30180
21. Ovchinnikova I.V., Gimranov A.M., Tazieva G.R., Busygin M.A., Korunova E.G. Preventive application of lymphovenous anastomoses in the axillary region simultaneously with lymphatic dissection in the treatment of breast cancer for the prevention of lymphedema of the upper extremity (LYMPHA technique). Surgery. N.I. Pirogov, 2024, № 2, рр. 42–47. (In Russ.). https://doi.org/10.17116/hirurgia202402242
22. Ng Z.Y., Chalhoub X., Furniss D. Surgical Treatment of Lymphedema in the Upper Extremity. Hand Clin., 2024, May; № 40(2), рр. 283–290. https://doi.org/10.1016/j.hcl.2023.10.005
23. Abdelfattah U., Elbanoby T., Ayad W., Elshamy M., Allam E. Treatment of secondary scrotal and lower extremity lymphedema using combined pedicled lymph node transfer and lymphaticovenous anastomosis: A case report. Microsurgery, 2020, Nov; № 40(8), рр. 901-905. https://doi.org/10.1002/micr.30656
24. Aldrich M.B., Rasmussen J.C., Fife C.E., Shaitelman S.F., Sevick-Muraca E.M. The Development and Treatment of Lymphatic Dysfunction in Cancer Patients and Survivors. Cancers (Basel), 2020, Aug 14; № 12(8), рр. 2280. https://doi.org/10.3390/cancers12082280
25. Forte A.J., Khan N., Huayllani M.T. et al. Lymphaticovenous Anastomosis for Lower Extremity Lymphedema: a systematic review. Indian J Plast Surg., 2020, № 53(1), рр. 17–24.
26. Clinckaert A., Callens K., Cooreman A. et al. The Prevalence of Lower Limb and Genital Lymphedema after Prostate Cancer Treatment: A Systematic Review. Cancers (Basel), 2022, № 14(22).
27. Scaglioni M.F., Meroni M., Fritsche E. Lymphovenous anastomosis (LVA) for treatment of secondary breast lymphedema: a case report and literature review. Microsurgery, 2021, № 41(2), рр. 165–169.
28. Boccardo F., Santori G., Villa G., Accogli S., Dessalvi S. Longterm patency of multiple lymphatic-venous anastomoses in cancer-related lymphedema: a single center observational study. Microsurgery, 2022, № 42(7), рр. 668–676.
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For citations:
Pakhomova R.A., Kopytich I.V. Surgical treatment of lymphostasis. Literature review. Moscow Surgical Journal. 2026;(1):224-228. (In Russ.) https://doi.org/10.17238/2072-3180-2026-1-224-228
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