Lymphaticovenous Anastomosis Reduces Pain in Selected Patients with Lower Limb Lymphedema.

Objectives: Lymphedema is a chronic condition characterized by fluid accumulation and limb swelling, often accompanied by pain. While complete decongestive therapy may reduce pain, some patients experience persistent symptoms. Lymphaticovenous anastomosis (LVA) is a minimally invasive procedure that has shown promise in alleviating pain, but the types of pain most responsive to LVA remain unclear. Methods: This retrospective study included 14 patients (12 women, 2 men; mean age 55.6 years) with lower limb lymphedema and pain who underwent LVA between August and December 2023. A total of 25 limbs were treated. Pain was assessed using a visual analog scale (VAS, 0-10), and pain characteristics were categorized. Limb circumference was measured at six points and summed. Preoperative and postoperative data were compared using paired t-tests. The mean follow-up duration was 268.4 days. Results: The mean preoperative VAS score was 3.1, which improved slightly to 2.9 postoperatively (p = 0.23); 5 patients (35.7%) experienced pain reduction, 6 (42.9%) had no change, and 3 (21.4%) reported worsening pain. Limb circumference improved significantly from 205.5 cm to 200.5 cm (p < 0.01). Pain improvement showed moderate correlation with changes in limb circumference (r = 0.42) and postoperative weight loss (r = 0.49). Subgroup analysis revealed greater pain reduction in patients who described their pain as "sharp" or "throbbing," whereas all patients who experienced worsening pain reported "heaviness." Conclusions: LVA may provide meaningful pain relief in selected patients with lower limb lymphedema, particularly those with sharp or throbbing pain. Limb volume reduction and postoperative weight loss appear to be associated with greater pain improvement.