End-to-End Sleeve Lymphaticovenous Anastomosis for Chronic Lymphedema

Microscopic end-to-end lymphaticovenous anastomosis is a time-consuming procedure that demands a high degree of surgical skill. To develop faster and simpler methods, the authors applied the technique of end-to-side sleeve anastomosis to lymphaticovenous anastomosis for chronic lymphedema.

Under local anesthesia and with small skin incisions, appropriate lymphatic vessels and veins were explored. After dissection of the lymphatic vessels and veins, the stump of the lymphatic vessel was inserted into the vein with only a single pull-through suture via the hole made at the venous wall in the end-to-side fashion.

This technique was used in two cases. Case 1: A 47-year-old woman had lymphedema of the left lower extremity after hysterectomy. Only one lymphaticovenous shunt was made at the ankle with this technique. Four months after surgery, the circumference of the ankle had decreased 3.5 cm. Case 2: A 64-year-old woman had lymphedema of the left arm after bilateral mastectomy. With this technique, one lymphaticovenular anastomosis was made at the wrist and one lymphaticovenous shunt was made at the dorsum of the hand. However, there was no significant improvement postoperatively.

The technique reported is simpler and easier to perform than end-to-end lymphaticovenous anastomosis. Although a long-term study of outcomes is necessary, the authors believe that this technique would be effective for treating cases of chronic lymphedema in which the lymphatic vessels are too small or too thin for end-to-end lymphaticovenous anastomosis.