A modified side-to-end lymphaticovenular anastomosis

Background: Lymphaticovenular anastomosis (LVA) is a useful treatment for compression-refractory lymphedema with its effectiveness and minimal invasiveness. However, LVA requires supermicrosurgery, where lymphatic vessels with a diameter of 0.5 mm or smaller are anastomosed using 11-0 or 12-0 suture. To make LVA easier and safer, we adopted a modified side-to-end (S-E) anastomosis in LVA surgery. Methods: We performed modified S-E LVAs in 14 limbs of female patients with lower extremity lymphedema (LEL). In modified S-E LVA, lateral windows with a length of 1.0 mm or longer were created on a lymphatic vessel and a vein, respectively, and side-to-side (S-S) anastomosis was established with 10-0 continuous suture. After completion of S-S anastomosis, the vein distal to the anastomosis site was ligated to prevent venous backflow and subsequent thrombosis at the anastomosis site. Lymphedematous volume was evaluated preoperatively and at postoperative 6 months using LEL index. Results: All the 24 modified S-E anastomoses could be completed without difficulty or revision for anastomosis, and showed good patency after completion of anastomosis. Postoperatively, LEL indices significantly decreased compared with preoperative LEL index (255.9 +/- 14.1 vs. 274.9 +/- 22.2, P < 0.001). Conclusions: Modified S-E LVA can efficaciously divert lymph flows into venous circulation without performing supermicrosurgical anastomosis. (c) 2012 Wiley Periodicals, Inc., Microsurgery, 2013.