Persistent retrograde venous-lymphatic reflux in side-to-end lymphaticovenous anastomosis in a lower extremity with lymphedema: a case report

End-to-end (ETE) and side-to-end (STE) anastomosis are two common configurations of lymphaticovenous anastomosis (LVA); however, it remains inconclusive which method is better. A 62-year-old man with lower extremity lymphedema underwent LVA with the STE method on the ankle. When the lymphatic vessel was cut for additional LVA at the proximal lower leg, blood drained out from the cut end of a lymphatic vessel, which suggested venous-lymphatic reflux at the STE anastomosis at the ankle. Because the reflux continued until 1 hour after the previous LVA at the ankle, the STE anastomosis at the ankle was re-explored and converted to ETE by ligation of the proximal lymphatic vessel. Reverse venous-lymphatic reflux was corrected, and a lymphovenous shunt was created immediately after the ligation. The current case suggests that STE anastomosis can be inferior to ETE anastomosis for creating a lymphovenous shunt when venous backflow exists.