Never fear the venous-lymphatic coupler is here!

Sharma, Pundrique R.; Sharma, Hrsikesa; Cyr, Michel St; Griffiths, Mat

doi:10.1016/j.bjps.2014.10.013

Cited by 4 publications

(3 citation statements)

References 2 publications

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“…Moreover, the use of a coupler device for the anastomosis, enabled by the relatively large caliber of the lymphatic vessel, is another unique feature of this case. Coupler devices are commonly used for venous anastomoses and rarely also for the arterial ones (Scaglioni & Meroni, 2023), but they are still rarely reported for lymphatic vessels due to their small size (Sharma et al, 2015; Sisk et al, 2020). The coupler's application likely contributed to the technical ease and successful outcome of the procedure.…”

Section: Discussionmentioning

confidence: 99%

The use of superficial circumflex iliac perforator (SCIP) pedicle vein for lymphovenous anastomosis to treat inguinal lymphatic fistula: A case report

Meroni,

Scaglioni

2024

Microsurgery

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The management of lymphatic fistulas following surgical procedures, in particular after inguinal lymphadenectomy, represents a significant clinical challenge. The current case report shows the novel use of the superficial circumflex iliac perforator (SCIP) pedicle vein for lymphovenous anastomosis (LVA) to treat a chronic inguinal lymphatic fistula in a 58‐year‐old male patient. This patient had developed a persistent lymphorrhea and wound dehiscence after a right inguinal lymph node biopsy performed for oncological reasons 1.5 months before. Pre‐operative assessment with indocyanine green (ICG) lymphography confirmed a substantial lymphatic contribution to the wound discharge, thus guiding the surgical strategy. During the procedure, a pedicled tissue segment containing the SCIV was dissected and utilized to fill the wound's dead space and facilitate LVA with the leaking lymphatic vessel. Notably, a coupler device was employed for the anastomosis due to the large caliber of the lymphatic vessel involved, a technique not commonly reported in lymphatic surgeries. The result of the procedure was successful, with intra‐operative ICG imaging confirming the patency of the anastomosis. After surgery the wound healed without complications. This case illustrates the potential of SCIV employment in lymphatic fistula repair in the inguinal region. While further research is needed to validate these findings, this report provides an unconventional approach to a relatively common problem in clinical practice.

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Section: Discussionmentioning

confidence: 99%

The use of superficial circumflex iliac perforator (SCIP) pedicle vein for lymphovenous anastomosis to treat inguinal lymphatic fistula: A case report

Meroni,

Scaglioni

2024

Microsurgery

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“…Yet, the published literature on this technique uniformly describes its use for joining lymphatics (>1mm) to veins of equal size and is examined in non-comparative case series. 4,[25][26][27] This study aims to 1) describe a novel approach to immediate lymphatic reconstruction that uses a venous coupler to assist in the implantation of lymphatic vessels (coupler-assisted bypass; CAB) and 2) compare the clinical outcomes of breast cancer patients undergoing ALND and immediate lymphatic reconstruction via standard hand-sewn bypass versus CAB techniques.…”

Section: Introductionmentioning

confidence: 99%

“…Yet, the published literature on this technique uniformly describes its use for joining lymphatics (>1 mm) to veins of equal size and is examined in noncomparative case series. 4 25 26 27…”

mentioning

confidence: 99%

Lymphovenous Coupler-Assisted Bypass for Immediate Lymphatic Reconstruction

Spoer,

Berger,

Towfighi

et al. 2023

J Reconstr Microsurg

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Background: Breast cancer-related lymphedema is the most common cause of lymphedema in the United States and occurs in up to 50% of individuals receiving axillary lymph node dissection (ALND). Lymphovenous bypass (LVB) at the time of ALND may prevent lymphedema, but long-term results and anastomotic patency are unclear. This study evaluates the feasibility and outcomes of performing immediate lymphatic reconstruction via coupler-assisted bypass (CAB). Methods: This is a retrospective review of all patients undergoing prophylactic LVB following ALND at two tertiary care centers between 2018-2022. Patients were divided into cohorts based on whether they received the ‘standard’ end-to-end (E-E) suturing or CAB technique. The primary outcome of interest was development of lymphedema. Quantitative and qualitative assessments for lymphedema were performed preoperatively and at 3, 6, 12, and 24 months postoperatively. Results: Overall, 63 lymphovenous bypasses were performed, of which 24 lymphatics underwent immediate reconstruction via “CAB” and 39 lymphatics via “standard” end-to-end suture. Patient characteristics, including BMI, and treatment characteristics, including radiation therapy, did not significantly differ between groups. CAB was associated with a greater mean number of lymphatics bypassed per vein (standard 1.7 vs. CAB 2.6 p=0.0001) and bypass to larger veins (standard 1.2 vs. CAB 2.2 mm, p<0.0001). At a median follow-up of 14.7 months, 9.1% (1/11) of individuals receiving CAB developed lymphedema. These rates were similar to those seen following standard bypass at 4.8% (1/21), although within a significantly shorter follow-up duration (standard 7.8 vs. CAB 14.7 months, p=0.0170). Conclusion: The CAB technique is a viable, effective technical alternative to the standard LVB technique. This comparative study of techniques in prophylactic LVB suggests that coupler-assisted bypasses maintain long-term patency, possibly due to the ease of anastomosing several lymphatics to single large caliber veins while reducing the technical demands of the procedure.

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