Lymphovenous Anastomosis Bypass Surgery

Abstract

The field of lymphedema surgery has witnessed tremendous advancements over the years and has been coupled to the rapid growth of supermicrosurgical techniques. A lymphovenous bypass or lymphaticovenular anastomosis is a new technique that requires identification of patent, residual lymphatic channels and performing an anastomosis to a recipient venule, thereby allowing outflow of lymphatic fluid and improvement in a patient's lymphedema. This article provides a summary of the maturation of the technique, as well as the technical aspects of the approach and the current outcomes in the treatment of postmastectomy lymphedema.

Keywords: lymphaticovenular anastomosis; lymphedema surgery; lymphovenous bypass.

Conflict of interest statement

Conflict of Interest None.

Figures

Fig. 1

Postmastectomy lymphedema syndrome demonstrating lymphedema of the arm following treatment for breast cancer.

Fig. 2

Indocyanine green (ICG) lymphangiography mapping of the upper extremity demonstrating the lymphatic channels that have absorbed the ICG.

Fig. 3

Lymphatic channels are identified following indocyanine green injection that dictates the location of the incision. Injection of Lymphazurin or isosulfan blue dye distal to the incision aids in the identification of the lymphatic vessels. However, not all lymphatic channels will absorb the dye, as shown here with two lymphatic vessels adjacent to each other, one with blue dye in the lumen and the other without it. Note the recipient venule in close proximity with the lymphatic vessels.

Fig. 4

A 6-0 Prolene suture is used to stent the lymphatic vessel open in order to make certain that the sutures are full thickness and not back-walling the lymphatic channel. The recipient venule is also dissected in close proximity to the lymphatic vessel.

Fig. 5

A completed anastomosis demonstrating drainage of the Lymphazurin blue dye into the recipient vein, confirming patency of the anastomosis.

Fig. 6

Postoperative photo of patient 6 months after a lymphovenous bypass or lymphaticovenular anastomosis demonstrating improvement of the lymphedema. Patient is no longer wearing compression sleeves and has not noted any increase in the size of the arm with worsening swelling since the operation.