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A Novel Application of Lymphovenous Bypass for the Treatment of Congenital Retroperitoneal Lymphangiectasia
David L. Kashan M.D., Eric J. Wenzinger M.D., Grzegorz J. Kwiecien M.D., Graham Schwarz M.D.
Cleveland Clinic Foundation
2018-02-15
Presenter: David Kashan, M.D.
Affidavit:
David Kashan
Director Name: Steven Bernard
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Abstract: Treatment of Symptomatic Congenital Retroperitoneal Lymphangiectasia with Lymphaticovenous Bypass
Purpose: Lympho-venous bypass (LVB) procedures provide an alternate approach for the treatment of chronic lymphatic malformations while preserving existing lymphatic architecture. Our team completed a lymphovenous bypass to improve lymphatic circulation and ultimately relieve unrelenting pain in a 47-year-old female with congenital retroperitoneal lymphangiectasia. The patient had previously undergone several attempts of percutaneous drainage and treatment with sclerosing agents without resolution of symptoms.
Hypothesis: The introduction of a venous shunt would provide definitive decompression of the dilated lymphatic channels, alleviating the patients pain and subjectively decreasing the extent of lower extremity lymphedema.
Methods: We completed a super-micro anastomosis of the venae comitantes of the external iliac artery to the sidewall of the largest retroperitoneal lymphatic cyst.
Conclusion: Post-operative imaging confirmed successful decompression of the lymphocele involved in the LVB. Six-month and fifteen-month follow-up supported our hypothesis with near complete resolution of the patient's pain and no significant enlargement or progression of lower extremity lymphedema. Our patient endorsed a subjective decrease in size of her lower extremity compared to her preoperative size. Lymphovenous bypass, in the setting of failed or inadequate conservative measures, for the treatment of both congenital and secondary lymphangiectasia may serve as an alternative to surgical excision and intraoperative sclerosing agents.
