Utilization of Recipient Veins with Reflux during Supermicrosurgical Lymphaticovenous Anastomosis for Lower Limb Lymphedema.

Background: The use of recipient veins with venous reflux for lymphaticovenous anastomosis (LVA) is discouraged because it is commonly believed that this may lead to venous-lymphatic reflux (VLR). VLR is a phenomenon in which venous blood is refluxed into the lymphatic lumen after anastomosis, potentially lowering the long-term patency rate. However, this concept is yet to be validated. This study aimed to determine the impact on outcomes when recipient veins with reflux were used for LVA in treating unilateral lower limb lymphedema.

Methods: Seventy-nine patients who underwent LVA as the primary treatment were enrolled. The study group included 31 patients who received only recipient veins with reflux. An additional 48 patients (control group) received only reflux-free veins. Patients with a history of LVA, liposuction, or excisional therapy were excluded. Patient characteristics, intraoperative findings, functional parameters, and pre-LVA and post-LVA volume changes were recorded and matched using propensity score matching. The primary endpoint was the volume change at 6 and 12 months after LVA.

Results: After matching, 28 patients were included in each group. All parameters were matched except the study variables, where the study group demonstrated significantly higher venous reflux (P < 0.001) and VLR ratio (P < 0.001). However, at the 6- and 12-month follow-up, the postoperative percentage volume reduction was comparable between the groups (P = 0.385 and 0.391, respectively).

Conclusion: When reflux-free veins are unavailable, using recipient veins with reflux for LVA is recommended.

Clinical question/level of evidence: Therapeutic, III.