Focus of the Report: This report focuses on the use of lymphovenous anastomosis (LVA) for the surgical treatment of patients with lymphedema.

Technology Description: LVA is a microsurgical procedure used to restore adequate lymphatic drainage from tissues of the upper or lower extremities by bypassing obstructed or damaged lymphatic vessels via the creation of one or more anastomoses that connect fully or partially functioning lymphatic vessels to small subdermal veins. The procedure is carried out under general or local anesthesia after mapping the vessels in the surgical site.

Controversy: Like all forms of surgery, LVA is inherently invasive and poses some risks. The long-term outcomes of LVA for lymphedema have not been well characterized and the role of LVA, other forms of lymphedema surgery, and adjunctive supporting treatment (e.g., compression garments, ongoing complex decongestive therapy) have not been well defined in comparative studies.

Key Questions: Key questions regarding the efficacy and safety of LVA in patients with upper or lower extremity lymphedema include:

  • Does LVA improve health outcomes in patients with lymphedema?

  • Is LVA safe in patients with lymphedema?

  • Have definitive patient selection criteria been identified for LVA in patients with lymphedema?

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