Practical solutions for lymphaticovenous anastomosis

Lymphedema is a chronic debilitating disease affecting a considerable part of the population that results from impairment of the lymphatic system. Lymphovenous anastomosis (LVA), a technique that attempts to achieve a physiologic lymphatic load of the edematous limb, is an accepted treatment. Techniques make anastomosis of 0.3 to 0.8 mm lymphatics to subdermal veins possible, but it is a challenge for microsurgeons because it requires a high degree of concentration and skill. An associated problem that we sometimes face when doing LVA is the absence of suitable veins in the proximity of an ideal lymphatic vessel. In situations like this, the presence of large veins with a higher diameter than the lymphatics is an alternative to consider. In these cases, end-to-side anastomosis is recommended. We describe a helpful technique to perform end-to-side LVA, using a thin catheter to create a round hole in the lateral wall of subdermal veins having the same diameter as the neighboring lymphatic that is going to be anastomosed. We also describe our personal modification of the intravascular stenting technique.