Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
, 39 (8), 763-772

Efficacy and Safety Assessment of Lymphovenous Anastomosis in Patients With Primary and Secondary Lymphoedema: A Systematic Review of Prospective Evidence


Efficacy and Safety Assessment of Lymphovenous Anastomosis in Patients With Primary and Secondary Lymphoedema: A Systematic Review of Prospective Evidence

Katharina Rosian et al. Microsurgery.


Introduction: Lymphoedema is a chronic, debilitating condition caused by an affected lymphatic system. Supermicrosurgical techniques like lymphovenous anastomosis (LVA) have gained popularity because of its minimal invasiveness, better aesthetic outcome, and lower costs in comparison to physical medicine. This systematic review aims to evaluate the clinical effectiveness and safety of LVA in comparison to conservative or other surgical treatments for primary or secondary lymphoedema patients.

Materials and methods: A systematic literature search was performed in four databases in December 2017. We applied a methodological framework based on the HTA Core Model®. According to the grading of recommendations, assessment, development, and evaluation (GRADE) scheme, we synthesized the data on each selected outcome category. The studies were systematically assessed for risk of bias (RoB) using the Risk of Bias Assessment tool for Non-randomized controlled studies (RoBANS) and the Institute of Health Economics (IHE) Risk of Bias checklist for case series.

Results: A total of 629 citations were identified and five studies were assessed eligible for final inclusion (one non-randomized controlled trial and four prospective single-arm studies). Across the studies, 217 patients were enrolled. All studies showed a moderate to high RoB. The strength of evidence for the effectiveness and safety of LVA is "very low." Due to the methodological shortcomings of the available evidence, no conclusions can be made about the effectiveness of the procedure.

Conclusion: LVA might be a safe technique for patients with primary and secondary lymphoedema-particularly because no serious complications were reported. Furthermore, LVA may have a role in the prevention of lymphoedema.

Conflict of interest statement

The authors have no financial conflicts or commercial associations to disclose.


Figure 1
Figure 1
PRISMA flow diagram outlining selection process of studies for analysis. PRISMA, preferred reporting items for systematic reviews and meta‐analyses
Figure 2
Figure 2
Reporting and risk of bias according to the IHE checklist—study level (case series), (n = 4)

Similar articles

See all similar articles


    1. Akita S., Mitsukawa N., Kuriyama M., Kubota Y., Hasegawa M., Tokumoto H., … Satoh K. (2015). Comparison of vascularized supraclavicular lymph node transfer and lymphaticovenular anastomosis for advanced stage lower extremity lymphedema. Annals of Plastic Surgery, 74(5), 573–579. - PubMed
    1. Allen R. J. Jr., & Cheng M.‐H. (2016). Lymphedema surgery: Patient selection and an overview of surgical techniques. Journal of Surgical Oncology, 113(8), 923–931. - PubMed
    1. Ayestaray B., & Bekara F. (2014). Pi‐shaped lymphaticovenular anastomosis: The venous flow sparing technique for the treatment of peripheral lymphedema. Journal of Reconstructive Microsurgery, 30(8), 551–560. - PubMed
    1. Boccardo F., Valenzano M., Costantini S., Casabona F., Morotti M., Sala P., … Campisi C. (2016). LYMPHA technique to prevent secondary lower limb lymphedema. Annals of Surgical Oncology, 23(11), 3558–3563. - PubMed
    1. Carl H. M., Walia G., Bello R., Clarke‐Pearson E., Hassanein A. H., Cho B., … Sacks J. M. (2017). Systematic review of the surgical treatment of extremity lymphedema. Journal of Reconstructive Microsurgery, 33(6), 412–425. - PubMed