INTRODUCTION: Lymphatic disruption can result in devastating lymphedema, chylothorax, chylous ascites, metabolic deficiencies, and/or death. Management can be conservative, minimally-invasive, or include surgical lymphovenous bypass. Treatment for peripheral flow derangements has been described, but not for that of central anomalies. Prior literature demonstrated the feasibility of lymphovenous anastomosis (LVA) for thoracic duct (TD) bypass. Here, we present an expanded case series investigating outcomes.
METHODS: A retrospective review was conducted for all adult patients whom underwent LVA for TD bypass by the senior-authors between 2018-2023. Demographic, etiological, and peri-operative information was collected. Radiographically confirmed patency or symptom resolution were considered successful bypasses.
RESULTS: A total of 24 patients (8M:16F) underwent 24 LVA procedures. Mean age was 49 years. Etiology of occlusion is shown in Figure 1. Anastomoses were made to the EJV (n=14), IJV (n=5), AJV (n=3), or another vein (n=2). Venous couplers were used in 21 cases. Procedural complications included lymphatic leak (n=4, requiring embolization/aspiration/ligation) and venous thrombosis (n=1). Mean follow-up was 9 months [5 days, 1.6 years]. Five patients required 6 re-operations for re-occlusion (n=1), aborted attempt at LVA (n=4), lymphatic leak (n=1). Patency was as follows: 12 patent (50%), 5 occluded, 7 unknown/lost to follow-up/pending further imaging.
CONCLUSION: LVA for TD bypass with an anastomotic coupler is safe and effective with admirable patency rates at follow-up. Additional long-term studies are warranted.