Changes in intracellular water volume after leg lymphedema onset and lymphaticovenular anastomosis as its surgical intervention

Yoshichika Yasunaga; Yuto Kinjo; Daisuke Yanagisawa; Shunsuke Yuzuriha; Shoji Kondoh

doi:10.1016/j.jvsv.2023.07.010

Changes in intracellular water volume after leg lymphedema onset and lymphaticovenular anastomosis as its surgical intervention

J Vasc Surg Venous Lymphat Disord. 2023 Nov;11(6):1243-1252. doi: 10.1016/j.jvsv.2023.07.010. Epub 2023 Aug 1.

Authors

Yoshichika Yasunaga¹, Yuto Kinjo², Daisuke Yanagisawa³, Shunsuke Yuzuriha³, Shoji Kondoh²

Affiliations

¹ Division of Plastic and Aesthetic Surgery, Ina Central Hospital, Ina, Japan; Department of Plastic and Reconstructive Surgery, Shinshu University School of Medicine, Matsumoto, Japan; Division of Plastic and Reconstructive Surgery, Shizuoka Cancer Center, Nagaizumi, Japan. Electronic address: y.yasunaga@scchr.jp.
² Division of Plastic and Aesthetic Surgery, Ina Central Hospital, Ina, Japan.
³ Department of Plastic and Reconstructive Surgery, Shinshu University School of Medicine, Matsumoto, Japan.

PMID: 37536561
DOI: 10.1016/j.jvsv.2023.07.010

Abstract

Objective: To clarify the changes in the intracellular water (ICW) volume in lymphedema-affected legs after lymphedema onset and its surgical intervention (ie, lymphaticovenular anastomosis [LVA]), we investigated the changes in body water composition using bioelectrical impedance analysis.

Methods: This retrospective case series included 41 women with unilateral secondary leg lymphedema. The volume changes in the ICW and extracellular water (ECW) of the affected leg were measured using an InBody S10 (InBody Co, Ltd) multifrequency bioelectrical impedance analyzer, at both lymphedema onset and 1 year after LVA.

Results: The volume increase with leg lymphedema onset was comparable between the ECW and ICW (0.59 L vs 0.56 L; 95% confidence interval [CI], -0.02 to 0.06; P = .27), and the increase rate was higher for ECW (35.3% vs 22.1%; 95% CI, 9.3%-17.2%; P < .001). The volume reduction at 1 year after LVA was comparable between ECW and ICW (0.23 L vs 0.27 L; 95% CI, -0.08 to 0.02; P = .20), and the reduction rate was higher for ECW (8.7% vs 7.0%, 95% CI, 0.04%-3.2%; P = .044). The volume difference between ICW and ECW remained constant throughout the six measurements before and after LVA (F[3.01, 120.20] = 1.85; P < .14).

Conclusions: Leg LVA reduced ICW in the lymphedematous leg. The onset of leg lymphedema increased ECW and ICW in the affected limb, and LVA decreased both ECW and ICW. The volume change in the affected leg was comparable between ECW and ICW at both lymphedema onset and after LVA. However, the rate of change was higher for ECW. The volume difference between ICW and ECW remained constant. Using bioelectrical impedance analysis, alterations in ICW volume were detected in the legs affected by lymphedema, both after the onset of lymphedema and after LVA intervention.

Keywords: Bioelectrical impedance analysis; Extracellular water; Intracellular water; Lymphaticovenular anastomosis; Lymphedema.