Lymphatic venous anastomosis

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Lymphatic venous anastomosis

Postby patoco » Sat Jun 23, 2007 2:10 am

Lymphatic-venous anastomosis

Vein grafting in the treatment of lymphedema

Microsurgery for treatment of peripheral lymphedema: Long-term outcome and future perspectives

Microsurgery. 2007

Campisi C, Eretta C, Pertile D, Da Rin E, Campisi C, Macciò A, Campisi M, Accogli S, Bellini C, Bonioli E, Boccardo F.
Department of Surgery, Unit of Lymphatic Surgery and Microsurgery, San Martino Hospital, University of Genoa, Genoa, Italy.

email: Corradino Campisi (campisicorradino@tin.it)

*Correspondence to Corradino Campisi, Department of Surgery, Unit of Lymphatic Surgery and Microsurgery, San Martino Hospital - University of Genoa, Largo R. Benzi 8, 16132 Genoa, Italy

Authors report over 30 years of their own clinical experience in the treatment of chronic peripheral lymphedemas by microsurgical techniques performed at the Center of Lymphatic Surgery of the University of Genoa, Italy. Over 1,500 lymphedema patients were treated with microsurgical techniques. Derivative lymphatic-venous techniques were most often used. For those cases where a venous disease was associated to lymphedema, reconstructive lymphatic microsurgery techniques were performed (lymphatic-venous-lymphatic-plasty). Objective assessment was undertaken by water volumetry and lymphoscintigraphy. Volume changes showed a significant improvement in over 83%, with an average follow-up of more than 10 years. There was an 87% reduction in the incidence of cellulitic attacks after microsurgery.

Microsurgical lymphatic-venous anastomoses have a place in the treatment of peripheral lymphedema and should be the therapy of choice in patients who are not sufficiently responsive to nonoperative treatment. Improved results can be expected with operations performed at earlier lymphedema stages. (c) 2007 Wiley-Liss, Inc. Microsurgery 2007

http://www3.interscience.wiley.com/cgi- ... 1&SRETRY=0

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Long-term results of microscopic lymphatic vessel-isolated vein anastomosis for secondary lymphedema of the lower extremities.

Surg Today. 2006

Matsubara S, Sakuda H, Nakaema M, Kuniyoshi Y.
Thoracic and Cardiovascular Surgery, Department of Bioregulatory Medicine, Faculty of Medicine, University of Ryukyus, 207 Uehara, Okinawa 903-0215, Japan.

PURPOSE: To evaluate the effectiveness of microscopic lymphatic vessel-isolated vein anastomosis in patients with secondary obstructive lymphedema of a lower extremity, refractory to nonoperative management.

METHODS: Nine women suffered from nonpitting edema of one or both legs (11 limbs) after radical hysterectomy with postoperative irradiation for uterine cancer. The indications for this operation were repeated cellulitis and severe nonpitting edema impairing limb function. Under microscopy of 3.2 on average, the identified lymphatic vessels were anastomosed to an isolated saphenous vein using the pull-through technique with modifications.

RESULTS: The follow-up period ranged from 21 to 87 months and the operation achieved excellent reduction, of more than 5 cm, in six limbs; good reduction, of 2-5 cm, in two limbs; and poor reduction, of less than 2 cm, in three limbs. The frequency of cellulitis decreased from 2.4 infections per patient per year to 0.2 infections per patient per year.

CONCLUSION: These results show that microscopic lymphatic vessel-isolated vein anastomosis is a minimally invasive operation, with good long-term effects, making it the treatment of choice for intractable secondary lymphedema of the lower extremities refractory to physiotherapy.

Key words: Secondary lymphedema - Microscopic lymphatic vessel-isolated vein anastomosis

http://www.springerlink.com/content/65n39n4m186006hl/

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Primary intrapelvic lymphaticovenular anastomosis following lymph node dissection.

2006

Takeishi M, Kojima M, Mori K, Kurihara K, Sasaki H.
Department of Plastic and Reconstructive Surgery , Jikei University School of Medicine, Minatoku Tokyo, Japan. takeishi@jikei.ac.jp

Lymphedema of lower extremities occurs following surgical resection of malignant tumors and intrapelvic lymph node dissection and is a long-term problem for patients. We performed primary intrapelvic lymphaticovenular anastomosis to prevent postoperative leg lymphedema. The procedures were conducted in 7 patients (aged 35-61 years) with cancer of the uterine body. After completion of hystero-oophorectomy and intrapelvic lymph node dissection, the afferent lymphatics entering internal and external iliac lymph nodes were end-to-end anastomosed with branches of the deep inferior epigastric veins. The time taken for constructing 4 anastomoses was 100 to 120 minutes. The follow-up period ranged from 10 to 18 months (mean, 14 months). All patients were discharged and are independent in daily living. Apart from mild leg lymphedema in 1 patient, no lymphedema was observed in other patients up to the last follow-up. This surgical modality is effective in preventing lymphedema in lower extremities after intrapelvic para-aortic lymph node dissection.

http://meta.wkhealth.com/pt/pt-core/tem ... 9000-00014

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Treatment of lymphedema with lymphaticovenular anastomoses.

Int J Clin Oncol. 2005 Oct

Nagase T, Gonda K, Inoue K, Higashino T, Fukuda N, Gorai K, Mihara M, Nakanishi M, Koshima I.
Department of Plastic and Reconstructive Surgery, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Tokyo 113-8655, Japan.

Key words: Lymphedema - Lymphaticovenular anastomosis - Supermicrosurgery - Lymphangiogenesis

Although lymphedema in the extremities is a troublesome adverse effect following radical resection of various cancers, conventional therapies for lymphedema are not always satisfactory, and new breakthroughs are anticipated. With the introduction of supermicrosurgical techniques for the anastomosis of blood or lymphatic vessels less than 0.8 mm in diameter, we have developed a novel method of lymphaticovenular anastomosis for the treatment of primary as well as secondary lymphedema in the extremities. Here, we review the pathophysiological aspects of lymphedema, emphasizing the importance of smooth-muscle cell function in the affected lymphatic walls. We then describe the theoretical basis and detailed operative techniques of our lymphaticovenular anastomoses. Although technically demanding, especially for beginners, we believe that this method will become a new clinical standard for the treatment of lymphedema in the near future.

http://www.springerlink.com/content/75u46k1jwu30382m/

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Vein graft interposition in treating peripheral lymphedema.

Handchir Mikrochir Plast Chir. 2003 Jul

Campisi C, Boccardo F.
Department of Specialistic Surgical Sciences, Anaesthesiology and Organ Transplants, Emergency Surgical Clinic Section, Lymphology and Microsurgery Centre, S. Martino Hospital, University of Genoa, Italy. campisi@unige.it

Key words
Reconstructive microsurgery - vein grafts - lymphoedemas - lymphatic-venous-lymphatic plasty - long-term results

The technique of interposed vein grafts (Lymphatic-Venous-Lymphatic Plasty: LVLA) consists in using autologous vein grafts to reconstruct lymphatic pathways where there is a block to the lymphatic circulation of the limb due to a congenital or acquired reason. The venous segment represents a sort of "bridge" between afferent and efferent lymphatic collectors. The study aims at evaluating long-term results of the treatment of peripheral lymphoedemas by the microsurgical reconstructive technique of LVLA. The results proved to be positive also in the long term after microsurgical operation. The follow-up was performed by water volumetry and isotopic lymphography. This technique of interposed vein grafts allows peripheral lymphoedemas to be treated when derivative lympho-venous shunts can not be used due to an impaired venous circulation in the same lymphoedematous limb.

http://www.thieme-connect.com/DOI/DOI?1 ... 2003-42130

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Microsurgical techniques for lymphedema treatment: derivative lymphatic-venous microsurgery

microsurgical lymphatic-venous anastomoses

World J Surg. 2004 Jun

Campisi C, Boccardo F.
Department of Specialistic Surgical Sciences, Anesthesiology, and Organ Transplants, Section of General and Emergency Surgery, Lymphology and Microsurgery Center, S. Martino Hospital, University of Genoa, Genoa, Italy.

We analyzed clinicopathologic and imaging features of chronic peripheral lymphedema to identify imaging findings indicative of its exact etiopathogenesis and to establish the optimal treatment strategy. One of the main problems of microsurgery for lymphedema is the discrepancy between the excellent technical possibilities and the subsequently insufficient reduction of the lymphedematous tissue fibrosis and sclerosis. Appropriate treatment based on pathologic studies and surgical outcome have not been adequately documented. Over the past 25 years, 676 patients with peripheral lymphedema have been treated with microsurgical lymphatic-venous anastomoses. Of these patients, 447 (66%) were available for long-term follow-up study. Objective assessment was undertaken by water volumetry and lymphoscintigraphy. Objectively, volume changes showed a significant improvement in 561 patients (83%), with an average reduction of 67% of the excess volume. Of the 447 patients followed, 380 (85%) have been able to discontinue the use of conservative measures, with an average follow-up of more than 7 years and average reduction in excess volume of 69%. There was an 87% reduction in the incidence of cellulitis after microsurgery. Microsurgical lymphatic-venous anastomoses have a place in the treatment of peripheral lymphedema and should be the therapy of choice in patients who are not sufficiently responsive to nonsurgical treatment. Improved results can be expected with operations performed early, during the first stages of lymphedema.

http://www.springerlink.com/content/101185/

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Microsurgical lympho-venous anastomosis in the treatment of secondary lymphoedema of the upper extremity

Handchir Mikrochir Plast Chir. 2003 Jul

Ingianni G.
Klinik für Plastische und Handchirurgie, HELIOS-Klinikum Wuppertal, Germany. plastische-chirurgie@wuppertal.helios-kliniken.de

Key words
Lympho-venous anastomosis - lymphatic microsurgery

At the end of the 1960's, lymphonodo-venous anastomosis has been performed by Olszewski and Nielubowicz experimentally as well as in clinical cases. Later on, various authors performed in clinical cases microsurgical anastomoses between lymphcollectors and veins. The rationality of this procedure is based on the knowledge that lymph always find the way back to the venous system, that the pressure of the lymph vessels is higher than in venous system of the extremities and that competent valves guarantee a centripetal flow. Beginning in the middle of the 1980's, we performed microsurgical end-to-end lympho-venous anastomoses in invagination technique for the treatment of secondary arm lymphoedema. The operation can be performed in local anesthesia, the anastomoses are performed on the proximal lower arm and on the medial portion of the upper arm. In each localisation three to four lympho-venous anastomoses are performed. Not only subjectively there is a decrease of the complaints but also variable reduction of the volume of the edematous arms can be achieved. In average the volume-reduction reaches 30 %. Data of a follow-up of 53 patients up to ten years show stable results.

This is a long-standing benefit and supports further conservative therapy as manual lymphdrainage. Nevertheless lymphoedema is a chronical and irreversible disease which cannot be definitively cured with operative or with conservative procedures.

http://www.thieme-connect.com/DOI/DOI?1 ... 2003-42129

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Long-term results after lymphatic-venous anastomoses for the treatment of obstructive lymphedema.

Microsurgery. 2001

Campisi C, Boccardo F, Zilli A, Macciò A, Napoli F.
Department of Specialistic Surgical Sciences, Anaesthesiology and Organ Transplants (DISCAT), Emergency Surgical Clinic Section, Lymphology and Microsurgery Center, S. Martino Hospital, University of Genoa, 16122 Genoa, Italy. campisi@unige.it

Over the past 25 years, 665 patients with obstructive lymphedema have been treated with microsurgical lymphatic-venous anastomoses; of these, 446 patients were available for long-term follow-up study. Objective assessment was undertaken by water volumetry and lymphoscintigraphy. Lymphangioscintigraphy, lymphangiography (in patients with gravitational reflux pathology), and echo-Doppler were used preoperatively. Subjective improvement was noted in 578 patients (87%). Objectively, volume changes showed a significant improvement in 552 patients (83%), with an average reduction of 67% of the excess volume. Of those patients followed up, 379 patients (85%) have been able to discontinue the use of conservative measures, with an average follow-up of more than 7 years and average reduction in excess volume of 69%. There was a 87% reduction in the incidence of cellulitis after microsurgery. In those patients who improved, drainage resulted in increased softness of the limbs. Peripheral edema (hand and foot) diminished considerably in most patients. These long-term results indicate that lymphatic-venous anastomoses have a place in the treatment of obstructive lymphedema and should be the therapy of choice in patients who are not sufficiently responsive to nonsurgical treatment. Improved results can be expected with earlier operations because patients referred earlier usually have fewer lymphatic alterations.

PMID: 11494379 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/sites/entre ... d_RVDocSum

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Pat O'Connor
Lymphedema People
http://www.lymphedemapeople.com
patoco
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