Damstra, R.J., Voesten, H.G., van Schelven, W.D., & van der Lei, B. (2009). Lymphatic venous anastomosis (LVA) for treatment of secondary arm lymphedema. A prospective study of 11 LVA procedures in 10 patients with breast cancer related lymphedema and a critical review of the literature. Breast Cancer Research and Treatment, 113(2), 199–206.

To evaluate the effectiveness of lymphatic venous anastomosis (LVA) in the treatment of one-sided, breast cancer-related lymphedema

Unilateral lymphoscintigraphy was done with attention to liver uptake, and methylene blue was used to outline the lymphatic system. An experienced microvascular surgeon did the LVA procedures doing end-to-side anastomoses with micro instruments. Antibitoitics were used preoperatively, and the extremity was bandaged and elevated at night. Patients were followed at three months, six months, one year, and beyond. The mean final follow up was eight years.

• The study sample was comprised of 10 female patients.
• Mean age was 58.7 years, with a range of 46-68 years.
• All patients were postmastectomy and had persistent lymphedema that had not responded to more conservative interventions.
• Lymphedema was present for a mean of 5.3 years before LVA.

The study took place at a single site in the Netherlands.

The study used a prospective descriptive design.

• Arm volume was measured using inverse water volumetry method.
• The SF-36 measured quality of life. 
• Indirect circumferential measurement of limbs was taken.
• Patients underwent lymphoscintigraphy. 

After six months, 5 of 10 patients had subjective relief according to SF-36 results. After one year, the mean volume difference between limbs was 1,075 cc, with a range of 500-1856, and the circumferential measurement demonstrated improvement of 4.8%. An initial postoperative volume reduction seen at 16% was lost in one year, at which time no more than a 2% difference between limbs was observed.

No significant improvements were found over the long term after an initial period of symptom relief and volume reduction.

• The study sample was small, with less than 30 patients.
• The study did not have a comparison or control group. 

The small prospective study suggests there is no long-term benefit of LVA surgery for management of lymphedema associated with breast cancer.