Reduction and discontinuation of compression therapy after lymphaticovenular anastomosis for upper extremity lymphedema.

Abstract

Lymphaticovenular anastomosis (LVA) is known to reduce edema and prevent cellulitis in patients with lymphedema. However, standardized criteria for reducing or discontinuing compression therapy have not been established, and stage-specific outcomes remain unclear. Therefore, we investigated the efficacy of LVA in achieving partial reduction or complete discontinuation of compression therapy in patients with secondary upper extremity lymphedema. We included 30 patients with secondary upper extremity lymphedema who underwent LVA and were followed for at least one year. Depending on the severity of edema, compression therapy was applied using elastic sleeves, gloves, and bandages. Compression therapy was reduced or discontinued according to predefined institutional criteria after postoperative improvement and clinical stability were confirmed. Among the 30 patients, 14 had stage 2a, 14 had stage 2b, and 2 had stage 3 lymphedema. The mean postoperative reduction in limb circumference was 4.5% ± 4.3%. The incidence of cellulitis decreased by 26.7% (from 30.0 to 3.3%). Complete discontinuation of compression therapy was achieved in 7 early-stage patients (50.0%) and in 0 advanced-stage patients (p = 0.0017). Partial reduction was observed exclusively in the advanced-stage group (8/16, 50.0%). LVA was associated with stage-specific modification of compression therapy. Early-stage patients are more likely to achieve complete discontinuation, whereas advanced-stage patients more likely achieved partial reduction. Furthermore, reduction in compression burden may contribute to improved quality of life. These findings support a stage-adapted treatment strategy for LVA in upper extremity lymphedema.