Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Dec 1;152(6):1350-1357.
doi: 10.1097/PRS.0000000000010865. Epub 2023 Jun 20.

The Deciding Factors of Flow Direction in Lymphovenous Anastomosis for Extremity Lymphedema

Ying-Sheng Lin  1   2 , Chia-Ju Liu  3
Affiliations

The Deciding Factors of Flow Direction in Lymphovenous Anastomosis for Extremity Lymphedema

Ying-Sheng Lin et al. Plast Reconstr Surg. .

Abstract

Background: While using lymphovenous anastomosis (LVA) to treat extremity lymphedema, an antegrade lymphatic-to-venous flow is usually considered to indicate a functional and effective anastomosis. The authors analyzed the characteristics of lymphovenous anastomoses in patients with extremity lymphedema to look for the deciding factors of the flow direction.

Methods: A total of 45 patients (15 arms and 42 legs) undergoing LVA for extremity lymphedema were reviewed. Only the anastomoses with intraoperatively confirmed patent flow or clear visualization of vessel lumens during anastomosis were included for analysis. Multivariate logistic regression was used to identify the contributing factors of intraoperative washout phenomenon or venous reflux.

Results: A total of 105 eligible LVAs were included for analysis. Anastomosis with a more sclerotic lymphatic duct is statistically significantly associated with more venous reflux (OR, 2.82; P = 0.003). Larger diameter difference between lymphatic duct and recipient vein (OR, 12.8; P = 0.02) and less sclerotic lymphatic duct (OR, 0.47; P = 0.03) are statistically significantly associated with more washout phenomena.

Conclusions: The deciding factors of flow direction in LVA are difference of diameters between lymphatic duct and recipient vein, and the severity of lymphosclerosis. To obtain favorable antegrade lymph-to-vein flow, a less sclerotic lymphatic duct with larger diameter and a recipient vein with smaller diameter should be chosen for anastomosis.

Clinical question/level of evidence: Risk, III.

PubMed Disclaimer

Similar articles

See all similar articles

References

    1. Grada AA, Phillips TJ. Lymphedema: diagnostic workup and management. J Am Acad Dermatol. 2017;77:995–1006.
    1. O’Brien BM, Sykes P, Threlfall GN, Browning F. Microlymphaticovenous anastomoses for obstructive lymphedema. Plast Reconstr Surg. 1977;60:197–211.
    1. O’brien B, Mellow CG, Khazanchi RK, Dvir E, Kumar V, Pederson W. Long-term results after microlymphaticovenous anastomoses for the treatment of obstructive lymphedema. Plast Reconstr Surg. 1990;85:562–572.
    1. Koshima I, Nanba Y, Tsutsui T, Takahashi Y, Itoh S. Long-term follow-up after lymphaticovenular anastomosis for lymphedema in the leg. J Reconstr Microsurg. 2003;19:209–215.
    1. Scaglioni MF, Fontein DB, Arvanitakis M, Giovanoli P. Systematic review of lymphovenous anastomosis (LVA) for the treatment of lymphedema. Microsurgery 2017;37:947–953.