title: π-shaped lymphaticovenular anastomosis: the venous flow sparing technique for the treatment of peripheral lymphedema.
abstract: BACKGROUND
  Nowadays, lymphaticovenular anastomosis has been recognized as an efficient microsurgical treatment for peripheral lymphedema. The technique based on two end-to-side anastomosis is named π-shaped lymphaticovenular anastomosis. This is the venous flow-sparing technique, in which the distal endothelial cells are not sacrificed. The purpose of this study is to evaluate the clinical results of π-shaped lymphaticovenular anastomosis in chronic lymphedema of the upper and lower limbs.
  
  
  METHODS
  From November 2010 to August 2011, 20 patients with a peripheral lymphedema were treated by π-shaped lymphaticovenular anastomosis. A total of 12 patients had a lymphedema of the upper limb and 8 patients had a lymphedema of the lower limb. The mean age of the patients was 57.2 years (range, 44-78 years). The mean duration of lymphedema was 6.2 years (range, 1-23 years). The Campisi clinical stage range 2 to 5 (average, 3.3). Every patient was operated under local anesthesia. Four π-shaped lymphaticovenular anastomoses were performed per limb.
  
  
  RESULTS
  The mean caliber of lymphatic vessels used for lymphaticovenular anastomosis was 0.55 mm (range, 0.3-0.8 mm). The mean caliber of subdermal venules was 1.2 mm (range, 0.5-2.1 mm).The average operative time to perform one π-shaped lymphaticovenular anastomosis was 55 minutes (range, 45-65 minutes). A venous backflow was found in 98 lymphaticovenular anastomosis (55.7%). Total 16 patients (80%) had a clinically significant circumferential reduction after surgery. The average volume differential reduction rate was 22.9% (range, 4.9-46.3) (p < 0.001).
  
  
  CONCLUSIONS
  π-Shaped lymphaticovenular anastomosis is a supermicrosurgical method with a low morbidity to treat peripheral lymphedema. The procedure can easily be performed under local anesthesia, and the postoperative recovery is short. The results of this series demonstrate a clinical efficiency of the technique to reduce chronic lymphedema of the limbs.EBM level IV.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Sud Francilien Hospital, University Paris Sud XI, Evry, France.
authors.forename: Benoit
authors.initials: B
authors.lastname: Ayestaray
authors.affiliation: Department of Plastic and Reconstructive Surgery, Sud Francilien Hospital, University Paris Sud XI, Evry, France.
authors.forename: Farid
authors.initials: F
authors.lastname: Bekara
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D005260:Female; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply / Q000601:surgery*; D042601:Lymphatic Vessels / Q000098:blood supply / Q000601:surgery*; D008209:Lymphedema / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D012720:Severity of Illness Index; D016896:Treatment Outcome; D034941:Upper Extremity / Q000098:blood supply / Q000601:surgery*; D014656:Vascular Surgical Procedures; D014699:Venules / Q000601:surgery*