Use of Teflon stents for lymphovenous anastomosis

Abstract

The treatment of lymphoedema is difficult; conservative and surgical management show variable results. Lymphovenous anastomoses (LVAs) in experimental animals and patients give poor results in the treatment of primary lymphoedema and variable results in that of secondary lymphoedema. Conventional sutured LVAs were compared with anastomoses using polytetrafluoroethylene (Teflon) stents; 32 sutured and 21 stented LVAs were constructed in 16 rabbits with normal lymphatics. Anastomoses were assessed for quality and patency at 1-16 weeks by direct exposure; 27 cases were further assessed using lymphangiography. Patency in stented and sutured LVAs was 71 and 38 per cent at 1 week, and 38 and 8 per cent at 3 weeks, respectively. After 4 weeks all anastomoses were occluded. The quality of stented LVAs seemed to be higher than that of sutured LVAs. Stented LVAs are feasible and probably superior to conventional sutured LVAs. However, the patency of LVAs is of short duration because of the disadvantageous pressure gradient from lymphatics to veins, and this limits their clinical application.

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

“…Our procedures for LVSEA have changed since May 2006, because ICG florescence lymphography and the stent method, 12 by which anastomoses can be performed more precisely, were introduced to our department at that time. The present study assessed midterm postoperative patency in LVSEA using ICG fluorescence lymphography in patients with peripheral lymphedema.…”

Lymphatic Microsurgical Preventive Healing Approach for the Primary Prevention of Lymphedema: A 4-Year Follow-Up

“…In animal models, Tourani et al reported obstruction of nearly 50% of LVAs at just 5 months postoperatively, 33 identifying lymphatic thrombosis because of retrograde venous flow as the likely reason for failure. [34][35][36][37] When comparing our LYMPHA technique to other published series, there is little variation, including the number of lymphatics anastomosed per patient. 20,23 Despite these similarities, it is still possible that subtle operative maneuvers may have a larger effect on long-term patency of LVAs.…”

Modified Preparatory Intravascular Stenting Technique in Super-microsurgical Lymphaticovenular Anastomosis for the Treatment of Lymphedema

“…2 Innovation techniques that have been reported to overcome these constraints can be divided into two categories: innovations in anastomotic technique and innovations in anastomotic configuration. [2][3][4][5][6][7][8][9] In early-stage lymphedema, the lymphatic vessels are not dilated, and it is challenging to secure the lymphatic lumen. In our report, the average outer diameter of lymphatic vessels anastomosed using the modified PIST was 0.36 mm (0.2-0.6 mm).…”

“…2 Innovation techniques that have been reported to overcome these constraints can be divided into two categories: innovations in anastomotic technique and innovations in anastomotic configuration. 2–9…”