203 posters, 14 topics, 5 sessions, 817 authors, 256 institutions
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The AAPS 102nd Annual Meeting
May 18-21, 2024 | The Westin Copley Place, Boston, MA
P47
Assessing The Efficacy Of Venous Couplers For Lymphovenous Anastomosis For Thoracic Duct Occlusion: An Examination Of Patency At Follow-up
Poster Presenter
Part of Topic
General Reconstruction/ Gender Affirmation
Assessing the Efficacy of Venous Couplers for Lymphovenous Anastomosis for Thoracic Duct Occlusion: An Examination of Patency at Follow-Up
Zachary Gala MD1, Jane Ewing BS1, Mehdi Lemdani MS, BA1, Dustin Crystal MD1, Selma Brkic RN2, Reed McGraw BA1, Christopher Amro MD1, Robyn Broach, PhD1, Said Azoury MD1, Max Itkin MD3, Stephen Kovach MD1
1.Department of Surgery, Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.
2.Critical Care Nurse, Penn Presbyterian Medical Center, Philadelphia, PA
3.Section of Interventional Radiology, Department of Radiology, University of Pennsylvania, Philadelphia, PA
§ Lymphatic disruption can result in devastating lymphedema, chylothorax, chylous ascites, metabolic deficiencies, and/or death.
§ Treatment of central lymphatic derangement are not described, and surgical intervention is only considered in severe or recalcitrant instances.
§ We aimed to demonstrate the feasibility of venous coupler anastomosis for lymphovenous bypass in central (thoracic duct) lymphatic occlusions.
§ All adult cases of lymphovenous anastomosis (LVA) for thoracic duct occlusion performed by the senior two authors were evaluated.
§ Basic demographics, imaging, and follow-up information was collected.
§ Statistical analysis was performed with SPSS (IBM, NY, USA) and Excel (Microsoft, WA, USA).
§ The thoracic duct is percutaneously cannulated and imaged intraoperatively.
§ The pathologic TD segment is exposed at the neck.
§ A suitable bypass conduit is identified [internal jugular (IJ), external jugular (EJ), anterior jugular (AJ), cephalic, or azygous veins].
§ Microsurgical anastomosis is performed with a Synovis venous coupler (Birmingham, AL, USA).
22 venous coupler anastomoses, 2 hand sewn
§ Average Age: 46.5 years
§ Mean Follow-up: 9 Months [5 days – 1.6 years]
§2 mortalities greater than 60 days post-procedure
§ Most Frequent Conduit: External jugular vein, 58%
§ Mean Coupler Size: 2.95mm
§Occlusion Etiology: Unknown (n=12; 50%), Iatrogenic (n=4; 16.7%), Lymphangiectasia (n=3; 12.5%), Malignancy (n=3; 12.5%); Traumatic (n=1; 4.1%), Congenital (n=1; 4.1%)
§Reoperation: Five patients required six re-operations
§Intra-operative patency was 100%
§Long Term Patency: 54%
§Of the 22 coupled anastomoses, 12 (55%) were patent
§ LVA utilizing a venous coupler for TD bypass is effective and safe.
§ Overall TD patency in 54% of patients who would otherwise be limited by recalcitrant disease.
§ Additional patient recruitment is ongoing.