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Groin Lymph Node to Vein Anastomosis- 'The Cleveland Clinic Experience and Technical Evolution'
Sonia Kukreja- Pandey, Wei F. Chen
Lymphatic Supermicrosurgery, Dept of Plastic Surgery, Cleveland Clinic, Ohio
2024-01-15
Presenter: Sonia Kukreja- Pandey
Affidavit:
The abstract has not been previously published or presented with the current data. This is original writing of the fellow based on my surgical work.
Director Name: Dr Wei F Chen
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Introduction:
Lymphaticovenular anastomosis (LVA) is effective but is technically demanding especially in previously debulked limbs. Also, proximal swelling (trunk and genitalia) are less responsive to distal LVA. Groin lymph node to vein anastomosis (LNVA) offers a potential solution by decompressing multiple lymph channels with one anastomosis in a naïve surgical field.
Methods:
Charts of patients who underwent LNVA between September 2022 and September 2023 were reviewed. 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(LN) and veins mapping. LN size, shape, echotexture, hilar blood flow and ICG flow direction guided target node selection. Anterior surface of the LN was punctured for side to end anastomosis with a nearby vein. Brisk lymph fluid egress was seen in 8/18 limbs. Average skin incision to LN exposure time was 3513 mins. In 2 limbs plan was converted to LVA in the groin due to no suitable LN intraoperatively. LNVA was performed alone (6/18), or with simultaneous LVA (8/18) or liposuction (4/18). Follow up ranged from 2 to 9 months. Amongst patients who underwent LNVA alone, 4/6 experienced symptoms reduction and improved ICG flow, while 2 had equivocal findings.
Conclusion:
Our systematic preoperative and operative strategies have streamlined safe execution of LNVA with encouraging early results.
