Use of Teflon stents for lymphovenous anastomosis

The treatment of lymphoedema is difficult; conservative and surgical management show variable results. Lymphovenous anastomoses (LVAs) in experimental animals and patients give poor results in the treatment of primary lymphoedema and variable results in that of secondary lymphoedema. Conventional sutured LVAs were compared with anastomoses using polytetrafluoroethylene (Teflon) stents; 32 sutured and 21 stented LVAs were constructed in 16 rabbits with normal lymphatics. Anastomoses were assessed for quality and patency at 1-16 weeks by direct exposure; 27 cases were further assessed using lymphangiography. Patency in stented and sutured LVAs was 71 and 38 per cent at 1 week, and 38 and 8 per cent at 3 weeks, respectively. After 4 weeks all anastomoses were occluded. The quality of stented LVAs seemed to be higher than that of sutured LVAs. Stented LVAs are feasible and probably superior to conventional sutured LVAs. However, the patency of LVAs is of short duration because of the disadvantageous pressure gradient from lymphatics to veins, and this limits their clinical application.