Lymphovenular anastomosis under local anesthesia for the patients at higher ASA PS score: benefits and results

Abstract

Aim: To evaluate the effectiveness of lymphovenular anastomosis (LVA) under local anesthesia for patients with high American Society of Anesthesiologists Physical Status (ASA PS) score.

Methods: From January 2019 to January 2021, we collected a total of 29 patients with lymphedema stage III and IV, operated upon with LVA by a single surgeon in a medical center. These patients had poor responses to compression therapies. After surgery, the patients underwent complex decongestive therapy consisting of the continuous wearing of an elastic stocking. To examine the effect of LVA, all data were collected, and differences in preoperative and postoperative means were analyzed.

Results: Twenty-nine patients with high ASA PS score (> 3) were followed after lymphovenular anastomosis and postoperative compression therapies. Twenty-one of 29 patients were survivors of oncological diseases and continued oncological therapies. The average duration of edema of these patients before LVA was 25 ± 5.0 years. The average number of anastomosis for each patient was 6.8 ± 2.2; the methods of anesthesia had no significant influence on these numbers. The average follow-up period was 7.8 ± 0.85 months, and the result was considered effective (26/29 patients; 89.7%). The average reduction of the circumference in affected limbs was 4.40% ± 3.67% of the preoperative excess length. There were no perioperative complications in this study.

Conclusion: Lymphovenular anastomosis can be performed under local anesthesia, especially in patients with high risks of general anesthesia (ASA PS score > 3). By this way, we could achieve adequate anastomosis and effective treatment of lymphedema in advanced cancer patients as well.

Keywords

Lymphedema / lymphovenular anastomosis / local anesthesia / complex decongestive therapy / advanced cancer patients / ASA PS score

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