Anastomotic Configurations

Supermicrosurgical lymphaticovenous anastomosis (LVA) is a bypass procedure that drains stagnant lymph by anastomosing lymphatic vessel (LV) to the recipient vein (RV) to achieve lymphedema reduction. Four anastomotic configurations are used for LVA, including lymphaticovenous end-to-end anastomosis (LVEEA), lymphaticovenous end-to-side anastomosis (LVESA), lymphaticovenous side-to-end anastomosis (LVSEA), and lymphaticovenous side-to-side anastomosis (LVSSA). These configurations utilize either antegrade or retrograde lymphatic flow, or both, for draining lymph. However, how to choose each configuration regarding their relative size and distance, as well as their advantages and disadvantages have not been properly discussed. Based on our most recent publication, retrograde anastomosis is not recommended.