Optimal Sites for Supermicrosurgical Lymphaticovenular Anastomosis: An Analysis of Lymphatic Vessel Detection Rates on 840 Surgical Fields in Lower Extremity Lymphedema Patients

Background: Supermicrosurgical lymphaticovenular anastomosis (LVA) is becoming a useful treatment option for progressive lower extremity lymphedema (LEL) with its minimal invasiveness. Finding lymphatic vessel is a minimum requirement for LVA surgery, but no study has reported comprehensive analysis on factors associated with lymphatic vessel detection (LVD). Methods: One hundred thirty-four female secondary LEL patients who underwent indocyanine green (ICG) lymphography and LVA without past history of lymphedema surgery were included. Medical charts were reviewed to obtain clinical, ICG lymphographic, and intraoperative findings. LVD was defined as positive when one or more lymphatic vessels were found in a surgical field of LVA. Logistic regression analysis was used to identify independent factors associated with LVD. Results: Patients' age ranged from 36 to 81 years, duration of edema from 3 to 324 months, and BMI from 16.2 to 33.3 kg/m2. Forty-eight patients (35.8%) had past history of radiation, and 76 patients (56.7%) had past history of cellulitis. LVAs were performed in 840 surgical fields, among which LVD was positive in 807 fields; overall LVD rate was 96.1%. Multivariate analysis revealed inverse associations in higher body mass index (odds ratio [OR] 0.323; P = 0.008) and S-region/D-region on ICG lymphography compared with L-region (OR 1.049 x 10-8/1.724 x 10-9; P