Lymphaticovenous shunt for the treatment of chylous reflux by subcutaneous vein grafts with valves between megalymphatics and the great saphenous vein: A case report

Abstract

Chylous reflux is a rare disorder in which chyle flows antidromically from its normal route to the extremities, thorax, abdominal cavity, or other parts of the body. We present a case of chylous reflux with megalymphatics in a 28-year-old boy who presented chylorrhea in the foot, leg, and external genitalia, lymphedema, and hemangioma in the affected limb. Lymphaticovenous shunts using subcutaneous vein grafts with valves were applied to the patient for treatment of repeated chylorrhea. After surgery, the patient has not complained of chylorrhea and been freed from conservative physiotherapy such as bandaging or application of compression stockings for lymphedema for two years. A subcutaneous vein graft with valves may be considered a useful method as a shunt between incompetent and dilated lymphatics and veins instead of a saphenous vein graft in the treatment of chylous reflux in lower extremities. We discuss these treatments based on the literature about chylous disorders.

Multisite Lymphaticovenular Anastomosis Using Vein Graft for Uterine Cancer-Related Lymphedema After Pelvic Lymphadenectomy

“…A vein graft can be used not only to connect a lymphatic vessel to a distant vein but also to prevent venous backflow by providing an intact valve within the grafted vein. 29,30 In SM-LVA, multiple lymphatic supermicrosurgeons simultaneously perform LVAs at different sites, one operating at the level of the groin and another at the thigh, and so on. 5,6 Usually, there are multiple veins at the groin and at the foot, whereas there are not as many suitable veins available for harvest at the thigh and at the leg.…”

Intra‐abdominal chylovenous bypass treats retroperitoneal lymphangiomatosis

“…The anastomosis itself is technically challenging, requiring multiple interrupted sutures while avoiding leakages and controlling internal bleeding. Continuous suturing is inadvisable, as this technique can narrow the anastomosis, resulting in low flow or thrombosis that could lead to inadequate chyle drainage.Maegawa et al described using vein grafts to resolve cutaneous chyle leakages in the lower limb from the dilated lymphatic duct to the adjacent saphenous vein at two levels 19. In comparison, we identified the intraabdominal abnormalities as the source of chylous ascites and chose to perform CVB from the incompetent tissue deep in the abdominal cavity to a low resistance path into the local venous system.…”