Lymphaticovenular

Lymphaticovenular refers to a microsurgical approach used to restore lymph drainage by creating a connection between a lymphatic vessel and a small vein, typically a venule, to bypass obstructed lymphatic flow. The procedure is commonly called lymphaticovenular anastomosis (LVA) and is used primarily to treat lymphedema.

Indications include primary lymphedema and secondary lymphedema (for example after oncologic surgery, radiation, or infection) affecting the limbs. Preoperative assessment uses imaging such as indocyanine green (ICG) lymphography, lymphoscintigraphy, and MRI to map functional lymphatic channels and suitable venules, identify leak points, and plan multiple anastomoses if needed.

Technique: performed under high magnification with microinstruments; lymphatic vessel (0.3–0.8 mm diameter) anastomosed to a nearby venule (similar size) using end-to-end or end-to-side configurations. Supermicrosurgical techniques, typically 9-0 or 10-0 nylon sutures, may be used. Procedures are often staged and can involve multiple anastomoses along the affected limb to optimize drainage. The operation is usually performed under local or general anesthesia and can be combined with lymphatic bypass or transfers in complex cases.

Outcomes: LVA can reduce limb volume, improve edema, decrease episodes of cellulitis, and improve symptoms and quality of life. The degree and duration of benefit vary; patency rates decline with time in some series. The success depends on lymphatic function and venous return, the presence of nonfunctional downstream tissue, and ongoing compression therapy postoperatively.

Complications and limitations: risks include infection, lymphatic leak, thrombosis, and persistent edema. LVA is often not curative and may require additional procedures or conservative management. It is one option among lymphedema therapies, sometimes used in combination with other procedures like vascularized lymph node transfer or debulking.