Introduction

Lymphovenous anastomosis (LVA) is a widely accepted method for treating lymphedema, and its efficacy could be largely affected by the severity of lymphosclerosis. In this study, we analyzed the intraoperative findings of lymphatic ducts in our patients receiving lymphovenous anastomosis to look for the predictive factors of the severity of lymphosclerosis.


Patients and Methods

The medical records of the patients receiving lymphovenous anastomosis for managing extremity lymphedema between September 2017 and December 2020 were reviewed. The severity of lymphosclerosis was evaluated intraoperatively under a surgical microscope and classified as normal, ectasia, contraction, or sclerosis type (NECST classification). Patients’ age, gender, body mass index (BMI), lymphoscintigraphy stage, and locations of lymphatic ducts were included for analysis.


Results

The multivariate linear regression analysis showed that location in lower extremity (Coefficient: -0.38, p = 0.03) and more advanced Taiwan lymphoscintigraphy staging (Coefficient: 0.27, p < 0.001) are associated with more severe lymphosclerosis. In a subgroup analysis in lower extremity, in addition to Taiwan lymphoscintigraphy staging (Coefficient: 0.24, p < 0.001), age (Coefficient: 0.02, p = 0.001) and BMI (Coefficient: 0.04, p = 0.005) are also positively related to the severity of lymphosclerosis.


Conclusions

The severity of lymphosclerosis in extremity lymphedema is positively correlated to Taiwan lymphoscintigraphy staging and more severe in lower limb lymphedema. In lower limb lymphedema, higher BMI and older age also contribute to more severe lymphosclerosis.