Factors Associated with Lymphosclerosis: An Analysis on 962 Lymphatic Vessels.

Background: Lymphaticovenular anastomosis (LVA) is a useful treatment option for compression-refractory lower extremity lymphedema (LEL), but its efficacy largely depends on severity of lymphosclerosis. To maximize LVA efficacy, it is important to elucidate factors associated with severe lymphosclerosis (SLS). Methods: Medical charts of 134 LEL patients who underwent preoperative indocyanine green (ICG) lymphography and LVA were reviewed to obtain data of clinical demographics, ICG lymphography findings, and intraoperative findings. Based on intraoperative findings of lymphatic vessels, severity of lymphosclerosis were classified into s0, s1, s2, and s3. Lymphatic vessels with s3 sclerosis was defined as SLS. Logistic regression analysis was used to identify independent factors associated with SLS. Results: In total, 962 lymphatic vessels were analyzed, among which SLS was observed in 97 (10.1%). Multivariate analysis revealed that independent factors associated with SLS were higher body mass index (odds ration [OR], 1.803; 95% confidence interval [CI], 1.041-3.123; P = 0.035), incision site in the thigh/foot compared with in the groin (OR, 2.355/4.471; 95% CI 1.201-4.617/2.135-9.362; P = 0.013/

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