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EFFECT OF PREGNANCY ON LOWER LIMB LYMPHEDEMA IN PATIENTS TREATED WITH MULTISITE LYMPHATICOVENULAR ANASTOMOSES (MLVAS)

I. Koshima, Sy. Yoshida, S. Nagamatsu, K. Yokota, H. Mizuta, M. Harima, K. Tashiro, Sh. Yamashita, I. Ratanshi, T. Eldahshoury

Abstract


Lymphaticovenular anastomosis (LVA) using
supermicrosurgical techniques is effective for
treating and preventing progression of lymphedema.
We analyzed the influence of pregnancy
on LVA in five patients from a total 2179 LVA
cases. Previous studies offer conflicting reports
on whether pregnancy worsens pre-existing
lymphedema. This is the first report on the
influence of pregnancy on lower limb lymphedema
previously treated by multisite LVA
(mLVA). Five patients with primary (n=4) and
secondary (n=1) lower leg lymphedema were
analyzed for this study. Patient age ranged
from 18 to 31 (average 22.6) years old with 4
right and 1 left extremities involved. Duration
of symptoms ranged from one to 19 (average
7.4) years and the periods of compression
therapy were from 1 to 19 years (6.6 years).
Four patients had single pregnancies and one
patient was multiparous with 3 pregnancies.
Final follow-up ranged from 5.8 to 18 years
(average 8.9 years) after the primary mLVA. All
patients had normal pregnancy, birth, and no
serious complications after surgeries. Following
pregnancy three patients had complete functional
recovery (limb volume reduction and no
compression requirement), one with functional
improvement (limb volume reduction but
required compression), and one with no change
in symptoms (not worse and continued need
for compression). There were no occurrences
of infection following pregnancy. Based on this
case series, it is suggested that pregnancy does
not worsen the pre-existing lymphedema in
patients who had previously undergone mLVA.
Further studies with larger number of patients
are needed to confirm these results.


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