The natural history of microsurgical lymphovenous anastomoses: an experimental study

Lymphovenous anastomoses have been suggested for the treatment of lymphedema, but the literature lacks evidence of late patency. To determine a method to verify patency, 57 lymphovenous anastomoses were performed in 34 dogs. In vivo cinelymphangiography gave convincing evidence of patency up to 8 months. Eight of 10 anastomoses were patent at 24 hours, 8 of 19 at 2 to 6 weeks, 4 of 6 at 3 months, and 2 of 6 at 8 months. Antiplatelet treatment did not decrease the thrombotic occlusion rate on the venous side, which was the main cause of failure. Scanning electron microscopy showed complete endothelial coverage of suture lines at 4 weeks. Because this study demonstrated that patency of lymphovenous anastomoses can be achieved, the procedure may be considered for the treatment of secondary lymphedema. The occlusion rate is high; therefore, chances of success are better with several anastomoses performed in the early stages of lymphedema, before significant tissue fibrosis and complete loss of lymphatic valvular function develop.