Patanè Luca, Kuo Pao-Jen, Ou Yu-Che, Chang Chad, Wu Shao-Chun, Lin Wei-Che, Chien Peng-Chen, Hsieh Ching-Hua, Yang Johnson Chia-Shen
From the Department of Surgery, Plastic Surgery Unit, Sapienza University of Rome.
Lymphedema Center, Division of Plastic and Reconstructive Surgery, Department of Surgery.
Plast Reconstr Surg. 2025 Jun 1;155(6):1034-1040. doi: 10.1097/PRS.0000000000011869. Epub 2024 Nov 11.
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.
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.
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).
When reflux-free veins are unavailable, using recipient veins with reflux for LVA is recommended.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
不鼓励将存在静脉反流的受区静脉用于淋巴管静脉吻合术（LVA），因为人们普遍认为这可能导致静脉 - 淋巴反流（VLR）。VLR是一种吻合术后静脉血反流至淋巴腔的现象，可能会降低长期通畅率。然而，这一概念尚未得到验证。本研究旨在确定在治疗单侧下肢淋巴水肿时，使用存在反流的受区静脉进行LVA对治疗结果的影响。
纳入79例接受LVA作为主要治疗的患者。研究组包括31例仅接受存在反流的受区静脉的患者。另外48例患者（对照组）仅接受无反流的静脉。排除有LVA、抽脂或切除治疗史的患者。记录患者特征、术中发现、功能参数以及LVA术前和术后的体积变化，并使用倾向评分匹配进行匹配。主要终点是LVA后6个月和12个月时的体积变化。
匹配后，每组纳入28例患者。除研究变量外，所有参数均匹配，研究组的静脉反流（P < 0.001）和VLR比率（P < 0.001）显著更高。然而，在6个月和12个月的随访中，两组术后体积减少百分比相当（分别为P = 0.385和0.391）。
当无法获得无反流静脉时，建议使用存在反流的受区静脉进行LVA。
临床问题/证据水平：治疗性，III级。
