ArticleBeijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences2026
[Super microsurgical lymphaticovenular anastomosis for limb lymphedema: An outcome analysis based on clinical stage and indocyanine green pattern].
Article in Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo investigate the differential efficacy of super-microsurgical lymphaticovenular anastomosis (LVA) for limb lymphedema stratified by International Society of Lymphology (ISL) stage and indocyanine green (ICG) lymphographic Yamamoto pattern, and to provide evidence-based guidance for patient selection.
methodsA retrospective analysis was performed on 32 patients with unilateral limb lymphedema admitted between December 2023 and April 2025. Preoperatively, the patients were classified into ISL stage Ⅰ-Ⅱ (30 cases) and stage Ⅲ (2 cases), and into ICG patterns of splash (6 cases), stardust (14 cases), and diffuse (12 cases). The primary endpoint was percentage reduction of limb volume (%REV) and limb circumferential reduction at 6 months postoperatively; secondary endpoints included anastomotic patency rate, cellulitis recurrence rate, compression garment downgrade rate, and patient satisfaction. One-way ANOVA with Bonferroni correction was used to compare %REV between ISL stages Ⅰ-Ⅱ and different ICG patterns; effect size was calculated with Cohen's
results(1) ISL stratification: the overall %REV of the patients with stages Ⅰ-Ⅱ was 53%±9%, including 63%±8% for stage Ⅰ and 50%±7% for stage Ⅱ; the %REV of the patients with stage Ⅲ was 36%±5% (descriptive result). (2) ICG stratification: %REV was 63%±6% for splash, 56%±7% for stardust, and 36%±4% for diffuse patterns (
conclusionLVA efficacy was significantly associated with both ISL stage and ICG pattern. The patients with splash pattern or at stage Ⅱ and below could achieve > 55% volume reduction and should be considered the primary indications for LVA. The patients with diffuse pattern or at stage Ⅲ disease might require adjunctive liposuction or vascularized lymph node transfer to improve outcomes. Preoperative evaluation combining ISL staging and ICG lymphography can provide a reliable basis for the selection of LVA surgical indications and the formulation of treatment plans.
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