Ultrasound elastography and 3D volumetry for early postoperative assessment after lymphovenous anastomosis in lower-limb lymphedema.

OBJECTIVES: Lymphovenous anastomosis (LVA) is an established standard of care in the surgical treatment of secondary lymphedema, especially of the lower limbs. However, objective postoperative evaluation remains challenging. Ultrasound elastography offers a quantitative evaluation tool for the assessment of tissue stiffness and may be employed for the detection of subtle postoperative changes in this context. METHODS: 12 consecutive patients with primary or secondary lower-limb lymphedema were enrolled in a pilot, prospective observational study with pre- and postoperative elastography and volumetric assessment within the scope of LVA treatment. All measurements were carried out at predefined anatomical regions using a fixed transducer setup to minimise operator bias. RESULTS: A trend toward postoperatively reduced calf stiffness was observed (-2.31 kPa; p=0.066, r=0.54). Additionally, we report significant changes in stiffness symmetry between healthy and affected thighs after LVA surgery (p=0.037, Cohen´s d -0.685 [95 %CI -1.105 to -0.040]). Postoperative changes in thigh and knee circumference correlated with elastography parameters (ρ=0.625-0.741; p≤0.030), while volumetric differences were not statistically significant. CONCLUSIONS: Ultrasound elastography may offer an adjunct for the detection of early, subclinical tissue remodelling following LVA surgery. Given its pilot study nature, these findings suggest a potential role for elastography as a complement to conventional measurements and more objective monitoring of surgical outcomes in lymphatic surgery.