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Clinical improvements after lymphovenous anastomosis (LVA) are believed to be associated with long-term patency rates of the anastomosis. Research though has shown a decrease in clinical effectiveness after LVA between 6 and 12 months. Consequently, the goal of this systematic review was to summarize the current evidence of short- and long-term patency rates after LVA supermicrosurgery.

A systematic literature review was conducted in Embase, Medline (Ovid), and Web of Science covering lymphedema, LVA, and patency/imaging. Citation chasing via Lens.org, Scopus, and Web of Science supplemented the primary search.

A total of 2’216 records were screened, of which 13 studies met the inclusion criteria. Short-term patency (<=12 months) after therapeutic LVA ranged from 32% to 93% in the current literature, whereas long-term (>12 months) rates vary from 36% to 97%. Prophylactic LVA demonstrated comparable durability, with patency rates of 80% at 18 months.

Considering the potential loss of patency in 20% to 60% of anastomoses over time, these findings support the practice of performing a minimum of two LVAs per patient to maintain functional lymphatic drainage in the long term.

Early surgical intervention is often assumed to improve outcomes in patients with secondary upper extremity lymphedema, as earlier disease stages may present with more favorable lymphatic architecture and less irreversible tissue damage. This study aimed to evaluate whether the timing of surgical intervention after lymphedema onset correlates with postoperative treatment response following lymphaticovenous anastomosis (LVA) or vascularized lymph node transfer (VLNT) and postoperative complication rates.

This retrospective cohort study included patients with secondary upper extremity lymphedema who underwent lymphatic surgery (LVA or VLNT) between 2015 and 2025. Surgical timing was defined as the interval between lymphedema diagnosis and surgical treatment. Preoperative absolute limb circumference of the affected upper extremity was assessed as a measure of baseline lymphedema severity. Treatment response was evaluated postoperatively using relative excess reduction rate (RERR). Postoperative complications were classified according to the Clavien–Dindo classification.

A total of 106 patients (46 LVA, 60 VLNT) with secondary upper extremity lymphedema were included. Earlier surgical intervention was not associated with lower baseline limb circumference. At up to 4 years of follow-up, no consistent differences in relative reduction of lymphedema were observed between patients treated earlier versus later after symptom onset or diagnosis. Comparable outcomes were seen across different time intervals to surgery for both LVA and VLNT. Furthermore, postoperative complication rates did not differ between earlier and later surgical intervention. Overall, earlier surgery did not demonstrate superior postoperative outcomes in this cohort.

In this cohort, earlier surgical intervention was not significantly associated with improved postoperative outcomes following LVA or VLNT. These findings suggest that earlier timing of lymphatic surgery alone may not predict superior clinical outcomes in patients with secondary upper extremity lymphedema. Surgical decision-making should therefore consider multiple patient- and disease-specific factors beyond timing alone.