Outcomes of lymphaticovenous side-to-end anastomosis in peripheral lymphedema

Maegawa, Jiro; Yabuki, Yuichiro; Tomoeda, Hiroto; Hosono, Misato; Yasumura, Keisuke

doi:10.1016/j.jvs.2011.08.062

Cited by 84 publications

(58 citation statements)

References 18 publications

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“…It is usually managed conservatively with complex decongestive physiotherapy; however, ongoing compliance, access to appropriately trained lymphedema specialists and cost of compression garments are barriers to successful prevention of disease progression . There are several surgical options for lymphedema patients including direct excision, liposuction, lymphaticolymphatic and lymphaticovenous anastomoses, as well as free flap transfers . Ablative treatments, such as direct tissue excision and liposuction work to remove excess and diseased tissue, reduce limb volume, and improve cosmesis.…”

Section: Discussionmentioning

confidence: 99%

Vascularized axillary lymph node transfer: A novel model in the rat

et al. 2015

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Vascularized lymph node transfer (VLNT) is a promising microvascular free flap technique for the surgical treatment of lymphedema. To date, few experimental animal models for VLNT have been described and the viability of lymph nodes after the transfer tested. We aimed to evaluate the feasibility of axillary VLNT in the rat. Lymph node containing flaps were harvested from the axillary region in 10 Lewis rats based on the axillary vessels. Flaps were transferred to the ipsilateral groin and end-to-side microanastomosis was performed to the femoral vessels using 10-0 sutures. Indocyanine green (ICG) angiography was used to confirm flap perfusion. On postoperative day 7, flaps were elevated to assess their structure and vessel patency. Hematoxylin and eosin staining was used to confirm the presence and survival of lymph nodes. All animals tolerated the procedure well. Immediate post-procedure ICG angiography confirmed flap perfusion. No signs of ischemia or necrosis were observed in donor extremities. At postoperative day 7, all flaps remained viable with patent vascular pedicles. Gross examination and histology confirmed the presence of 3.6 ± 0.5 lymph nodes in each flap without any signs of necrosis. This study showed that the transfer of axillary lymph nodes based on the axillary vessels is feasible. The flap can be used without the need for donor animals and it contains a consistent number of lymph nodes. This reliable VLNT can be further utilized in studies involving lymphedema, transplantation, and induction of immunologic tolerance.

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Section: Discussionmentioning

confidence: 99%

Vascularized axillary lymph node transfer: A novel model in the rat

et al. 2015

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“…Lymphedema in humans is a chronic condition caused by disruption of lymphatic drainage, often after lymph node resection and radiation therapy. In extreme cases, supermicrosurgical lymphaticovenular anastomosis may be indicated [36,37], but the operation is not curative, and continued therapy remains necessary. On the other hand, in some cancers, invasion of the lymphatic system enables transport of tumor cells to distant lymph nodes and organs.…”

Section: Discussionmentioning

confidence: 99%

Functional differentiation of RAMP2 and RAMP3 in their regulation of the vascular system

Yamauchi

Sakurai

Kamiyoshi

et al. 2014

Journal of Molecular and Cellular Cardiology

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Adrenomedullin (AM) is a vasoactive peptide that possesses various bioactivities. AM receptors are dimers consisting of CLR with one of two accessory proteins, RAMP2 or RAMP3. The functional difference between CLR/RAMP2 and CLR/RAMP3 and the relationship between the two receptors remain unclear. To address these issues, we generated RAMP2 and RAMP3 knockout (−/−) mice and have been studying their physiological activities in the vascular system. AM−/− and RAMP2−/− mice die in utero due to blood vessel abnormalities, which is indicative of their essential roles in vascular development. In contrast, RAMP3−/− mice were born normally without any major abnormalities. In adult RAMP3−/− mice, postnatal angiogenesis was normal, but lymphangiography using indocyanine green (ICG) showed delayed drainage of subcutaneous lymphatic vessels. Moreover, chyle transport by intestinal lymphatics was delayed in RAMP3−/− mice, which also showed more severe interstitial edema than wild-type mice in a tail lymphedema model, with characteristic dilatation of lymphatic capillaries and accumulation of inflammatory cells. In scratch-wound assays, migration of isolated RAMP3−/ − lymphatic endothelial cells was delayed as compared to wild-type cells, and AM administration failed to enhance the re-endothelialization. The delay in re-endothelialization was due to a primary migration defect rather than a decrease in proliferation. These results suggest that RAMP3 regulates drainage through lymphatic vessels, and that the AM-RAMP3 system could be a novel therapeutic target for controlling postoperative lymphedema.

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“…It is important to make as many bypasses as possible for maximization of the treatment efficacy of LVA, because one anastomosis can divert only a small amount of lymph fluid into venous circulation and has a risk of anastomosis site thrombosis even with an intima‐to‐intima coaptation method . Therefore, lymphatic supermicrosurgeons should anastomose as many lymphatic vessels available in a surgical field as possible using 4 basic types of LVAs; end‐to‐end (E‐E), end‐to‐side (E‐S), side‐to‐end (S‐E), and S‐S .…”

Section: Discussionmentioning

confidence: 99%

“…It is important to evaluate postoperative anastomosis patency, because LVA surgery is considered to improve lymphedema by diverting congested lymph into venous circulation via created anastomoses. ICG lymphography, which has been reported to be useful for pathophysiological evaluation of obstructive lymphedema, allows postoperative evaluation of anastomosis patency . However, postoperative evaluation of LVA patency is possible, only when an anastomosis was performed where the skin is not thick (<2 cm) and ICG lymphography does not show dermal backflow patterns.…”

Section: Discussionmentioning

confidence: 99%

Ladder-shaped lymphaticovenular anastomosis using multiple side-to-side lymphatic anastomoses for a leg lymphedema patient

et al. 2013

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Lymphatic supermicrosurgery, supermicrosurgical lymphaticovenular anastomosis (LVA), is becoming a useful option for the treatment of compression-refractory lymphedema. One of the most important points in LVA is to make as many bypasses as possible for better treatment results. We report a progressive lower extremity lymphedema (LEL) case successfully treated with a ladder-shaped LVA. A 67-year-old female with secondary LEL refractory to conservative treatments underwent LVA. A ladder-shaped LVA was performed at the left ankle. In the ladder-shaped LVA, 3 lymphatic vessels and 1 vein were anastomosed in a side-to-side fashion; 2 lymphatic vessels next to the vein were anastomosed to the vein, and the other lymphatic vessel was anastomosed to the nearby lymphatic vessel. Using ladder-shaped LVA, 6 lymph flows of 3 lymphatic vessels could be bypassed into a vein. Six months after the LVA operation, her left LEL index decreased from 212 to 195, indicating edematous volume reduction. Ladder-shaped LVA may be a useful option when there are 3 lymphatic vessels and 1 vein in a surgical field.

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Outcomes of lymphaticovenous side-to-end anastomosis in peripheral lymphedema

Abstract: Although further study is required to determine factors leading to anastomotic obstruction and to optimize the results of microlymphatic surgery, the present LVSEA technique appears promising.

Cited by 84 publications

References 18 publications

Vascularized axillary lymph node transfer: A novel model in the rat

Vascularized axillary lymph node transfer: A novel model in the rat

Functional differentiation of RAMP2 and RAMP3 in their regulation of the vascular system

Ladder-shaped lymphaticovenular anastomosis using multiple side-to-side lymphatic anastomoses for a leg lymphedema patient

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