American Association of Plastic Surgeons

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Inguinal Lymph Node to Vein Anastomosis - 'The Cleveland Clinic Experience and Technical Refinements'
Sonia Kukreja-Pandey, MD1, Elizabeth A Bailey, MD2, Wei F Chen, MD1
1Cleveland Clinic, Cleveland, OH, USA, 2University of Pittsburgh, Pittsburgh, PA, USA

PURPOSE: Lymphaticovenular anastomosis (LVA) is effective and minimally invasive but is technically demanding. Also, lower trunk and genital swelling are less responsive to distal LVA. Inguinal lymph node to vein anastomosis (LNVA) offers a potential solution by decompressing lymph channels from multiple lymphosomes with a single anastomosis.
METHODS: We retrospectively reviewed patients undergoing LNVA from September 2022 to September 2023. Demographics, indications, and procedural strategies were analyzed. Postoperative outcomes were assessed using standardized measures.
RESULTS: Nineteen patients (11 females, 8 males; age 14-68 years) underwent 18 LNVA procedures. Indications included genital/lower truncal swelling (10/19), prior leg LVA (3/19), or leg liposuction (6/19). Groin ultrasound, indocyanine green (ICG), isosulphan blue injections, lymphoscintigraphy, Savi Scout and vein finder were used for lymph nodes and veins mapping. Lymph node size, shape, echotexture, hilar blood flow and ICG flow direction guided target node selection. Anterior surface of the lymph node was punctured for side to end anastomosis with a nearby vein. Brisk lymph fluid egress was seen in 8/18 limbs. In 2 limbs plan was converted to LVA in the groin due to no suitable lymph nodes. LNVA was performed alone (6/18), or with simultaneous LVA (8/18) or liposuction (4/18). Twelve patients have demonstrated clinical improvement while 5 reported no change.
CONCLUSION:Our systematic preoperative and operative strategies have streamlined safe execution of LNVA with encouraging early results.


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