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CC BY-NC 4.0 · Arch Plast Surg 2021; 48(02): 219-223
DOI: 10.5999/aps.2020.01704
Extremity/Lymphedema
Original Article

Micro-arteriovenous fistula in patients with lower limb lymphedema

Hikaru Kono 
Department of Plastic and Reconstructive Surgery, Tachikawa Hospital, Tachikawa, Japan
,
Hisashi Sakuma 
Department of Plastic and Reconstructive Surgery, Ichikawa General Hospital, Ichikawa, Japan
,
Shiho Watanabe 
Department of Plastic and Reconstructive Surgery, Keio University Hospital, Tokyo, Japan
,
Takaya Murayama 
Department of Vascular Surgery, Murayama Clinic, Yokohama, Japan
,
Masashi Takemaru 
Department of Plastic and Reconstructive Surgery, Yokohama Municipal Citizen’s Hospital, Yokohama, Japan
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Background A micro-arteriovenous fistula (AVF) is a minute, short shunt between an artery and a vein that does not pass through a capillary. We investigated the association between micro-AVFs and lymphedema using computed tomography angiography (CTA) and venous blood gas analysis.

Methods In 95 patients with lower limb lymphedema, the presence or absence of early venous return (EVR) was compared between patients with primary and secondary lymphedema. Furthermore, we investigated the difference in the timing of edema onset in patients with secondary lymphedema with or without EVR using CTA. In 20 patients with lower limb lymphedema with confirmed early EVR in a unilateral lower limb, the partial pressure of oxygen (PO2) was compared between the lower limb with EVR and the contralateral lower limb.

Results Secondary lymphedema with or without EVR occurred at an average of 36.0±59.3 months and 93.5±136.1 months, respectively; however, no significant difference was noted. PO2 was 57.6±11.7 mmHg and 44.1±16.4 mmHg in the EVR and non-EVR limbs, respectively, which was a significant difference (P=0.005).

Conclusions EVR and venous blood gas analysis suggested the presence of micro-AVFs in patients with lower extremity edema. Further research is warranted to examine the cause of micro-AVFs, to advance technology to facilitate the confirmation of micro-AVFs by angiography, and to improve lymphedema by ligation of micro-AVFs.

Keywords

Lymphedema - Arteriovenous fistula - Venous insufficiency - Venous hypertension - Computed tomography angiography


Publikationsverlauf

Eingereicht: 24. August 2020

Angenommen: 11. November 2020

Artikel online veröffentlicht:
07. März 2022

© 2021. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

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