Arch Hand Microsurg.  2022 Sep;27(3):274-278. 10.12790/ahm.22.0033.

Persistent retrograde venous-lymphatic reflux in side-to-end lymphaticovenous anastomosis in a lower extremity with lymphedema: a case report

• Woo KJ
• Lee MK
• Park JW

• KMID: 2532746
• DOI: http://doi.org/10.12790/ahm.22.0033

Abstract

End-to-end (ETE) and side-to-end (STE) anastomosis are two common configurations of lymphaticovenous anastomosis (LVA); however, it remains inconclusive which method is better. A 62-year-old man with lower extremity lymphedema underwent LVA with the STE method on the ankle. When the lymphatic vessel was cut for additional LVA at the proximal lower leg, blood drained out from the cut end of a lymphatic vessel, which suggested venous-lymphatic reflux at the STE anastomosis at the ankle. Because the reflux continued until 1 hour after the previous LVA at the ankle, the STE anastomosis at the ankle was re-explored and converted to ETE by ligation of the proximal lymphatic vessel. Reverse venous-lymphatic reflux was corrected, and a lymphovenous shunt was created immediately after the ligation. The current case suggests that STE anastomosis can be inferior to ETE anastomosis for creating a lymphovenous shunt when venous backflow exists.

Keyword

Lymphedema; Lymphovenous shunt; Lymphaticovenous anastomosis; Side to end; End to end

Figure

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  Fig. 1. Preoperative lymphoscintigraphy. (A) Anterior and (B) posterior views. After injecting radiotracer into the subcutaneous area of the first and second interdigital spaces of both feet, whole-body imaging was performed at 1 hour. Lymphatic obstruction in the left lower extremity was revealed.

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  Fig. 2. Intraoperative image. Yellow arrows indicate the lymphatic vessel, and red arrows indicate the vein. (A) Side-to-end (STE) lymphaticovenous anastomosis (LVA) at the ankle incision. The lymphatic vessel of the ankle incision is indicated by a yellow arrow. Lymphovenous shunt was not noted, and retrograde venous-lymphatic reflux was observed. (B) After about 30 minutes, venous flow through the cut end of the lymphatic vessel was detected in the proximal lower leg (yellow arrow). The venous outflow through the proximal lymphatic vessels continued and was not corrected during surgery. (C) The LVA site at the ankle was re-explored. Proximal end ligation of the lymphatic vessel on the ankle incision site was performed to convert STE into end-to-end anastomosis, which created a lymphovenous shunt. (D) Left lower leg showing the incision sites for LVA.

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  Fig. 3. (A) Preoperative image. (B) Postoperative 4-month image.

Reference

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