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Side-to-end Lymphaticovenular anastomosis through temporary lymphatic expansion.


ABSTRACT:

Objective

The number of bypasses is the most important factor in lymphaticovenular anastomosis (LVA) for lymphedema treatment. Side-to-end (S-E) LVA, which can bypass bidirectional lymph flows via one anastomosis, is considered to be the most efficient bypass, but creation of lateral window to a small lymphatic vessel is technically demanding. To overcome the difficulty, we introduced S-E anastomosis through temporary lymphatic expansion (SEATTLE) procedure in S-E LVA.

Methods

This was a retrospective observational study set in a teaching hospital. Forty eight lower extremity lymphedema (LEL) patients underwent LVA. S-E LVAs were performed with (SEATTLE group) or without (non-SEATTLE group) temporary lymphatic expansion. S-E LVAs were evaluated to compare anastomosis result in SEATTLE and non-SEATTLE groups.

Results

S-E LVAs resulted in 44 anastomoses in SEATTLE group (n?=?25) and 37 anastomoses in non-SEATTLE group (n?=?23). LEL index reduction in SEATTLE group was significantly greater than that in non-SEATTLE group (16.5±14.5 vs. 10.9±11.8, P?=?0.041). Success rate of S-E LVA in SEATTLE group was significantly higher than that in non-SEATTLE group (95.5% vs 81.1%, P?=?0.040). Thirty seven of 44 (84.1%) lymph vessels in SEATTLE group were successfully dilated by temporary lymphatic expansion maneuver. All of 9 failed S-E LVAs used a lymphatic vessel with diameter of 0.35 mm or smaller.

Conclusions

The SEATTLE procedure facilitates S-E LVA by a simple and easy maneuver. When the diameter of the lymphatic vessel is 0.35 mm or smaller even after the temporary lymphatic expansion maneuver, S-E LVA is not recommended due to relatively high failure rate.

SUBMITTER: Yamamoto T 

PROVIDER: S-EPMC3607574 | biostudies-literature | 2013

REPOSITORIES: biostudies-literature

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Publications

Side-to-end Lymphaticovenular anastomosis through temporary lymphatic expansion.

Yamamoto Takumi T   Yoshimatsu Hidehiko H   Yamamoto Nana N   Narushima Mitsunaga M   Iida Takuya T   Koshima Isao I  

PloS one 20130325 3


<h4>Objective</h4>The number of bypasses is the most important factor in lymphaticovenular anastomosis (LVA) for lymphedema treatment. Side-to-end (S-E) LVA, which can bypass bidirectional lymph flows via one anastomosis, is considered to be the most efficient bypass, but creation of lateral window to a small lymphatic vessel is technically demanding. To overcome the difficulty, we introduced S-E anastomosis through temporary lymphatic expansion (SEATTLE) procedure in S-E LVA.<h4>Methods</h4>Thi  ...[more]

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