The lymphovenous microsurgical shunts for treatment of lymphedema of lower limbs: indications in 2011.

The microsurgical lympho-venous shunts have become one of the generally accepted modalities in treatment of limb lymphedema. This review highlight the indications for this procedure after over 40 years. This study was based on the personal experience of one surgeon and on the review of the literature. Patients with postinflammatory, postsurgical, idiopathic and hyperplastic lymphedema of lower limbs were included in the study. Basing on the review of results of the last 40 years the contemporary indications are: 1) lymphedema with local segmental obstruction but still partly patent distal lymphatics seen on functional lymphoscintigraphy (standard walking or pneumatic compression) and without an active inflammatory process in the skin, subcutaneous tissue and lymph vessels (DLA-dermatolymphangioadenitis); 2) classified according the etiology of lymphedema, this operation can bring about satisfactory results in cases of hyperplastic, postsurgical and postinflammatory types of lymphedema, whereas primary idiopathic lymphedema of non-genetic type should be treated with conservative means, although in a small number of cases an improvement was observed after lympho-venous shunting as long as 10 years. Microsurgical lymph node or lymphatic vessel to vein shunts have their established position among the therapy modalities for lymphedema of lower limbs in a strictly defined group of patients using lymphoscintigraphic imaging.