Abstract
ABSTRACT
Secondary lymphedema remains a common complication after oncologic lymph node dissection. The optimal timing of lymphaticovenous anastomosis (LVA) is unclear due to a lack of time‐dependent large‐animal models. Twenty‐five New Zealand White rabbits underwent popliteal‐region surgery to induce secondary hind limb lymphedema. Animals received immediate LVA (
n
= 5) or delayed LVA at 4, 8, or 12 weeks after model induction (
n
= 5 per group); untreated lymphedema controls were included (
n
= 5). Outcomes included limb circumference/swelling rate, anastomotic patency by indocyanine green (ICG) fluorescence imaging, and histopathology/molecular markers (e.g., VEGF‐C, LYVE‐1). The model produced sustained hind limb swelling and molecular evidence of lymphangiogenic remodeling (e.g., increased VEGF‐C and LYVE‐1). Immediate LVA achieved 100% technical success with durable patency during follow‐up. Delayed LVA groups demonstrated patency rates of approximately 75%–80%. Immediate intervention resulted in the greatest long‐term reduction in swelling compared with delayed interventions. Mean lymphatic and venous diameters were approximately 0.6 and 0.8 mm, respectively, and mean operative time was ~55 min. This rabbit model provides a reproducible platform to evaluate time‐dependent LVA efficacy. Earlier intervention yielded superior functional outcomes, while delayed LVA remained feasible and maintained reasonable patency, supporting a clinically relevant therapeutic window.