Long-term comparative effectiveness of microsurgical treatment options for lower limb lymphedema: Lymphovenous anastomosis vs. vascularized lymph node transfer

OBJECTIVE: Lower limb lymphedema (LLL) is a debilitating disease affecting millions of people worldwide. Lymphovenous anastomosis (LVA) and vascularized lymph node transfer (VLNT) are microsurgical techniques known to improve lymphatic drainage capacity. Despite their promising outcomes in treating upper extremity lymphedema, their effectiveness in the lower extremity remains inadequately studied, leaving a critical knowledge gap. METHODS: Patients who underwent unilateral VLNT or LVA for LLL between January 2015 and December 2023 were included in this retrospective cohort study. Data were collected prospectively and required a minimum postoperative follow-up of one year for inclusion. Leg circumferences were measured at regular follow-up intervals, enabling a comparative analysis of their temporal profiles. RESULTS: Out of the 188 patients evaluated, 151 met the inclusion criteria, among them 123 (81.5%) underwent LVA and 28 (18.5%) VLNT. Although LVA demonstrated rapid improvements within the first three months after surgery, VLNT displayed a slower but steady increase in effectiveness throughout the one-year follow-up period, gradually narrowing the gap in effectiveness between the two techniques over time. Two postoperative complications occurred in the VLNT group, whereas no complications were observed in the LVA group. CONCLUSION: LVA demonstrates greater short-term improvements, independent of the number of anastomoses performed, whereas VLNT exhibits more gradual improvements over time.