A NEW COMBINED OPERATIVE TECHNIQUE USING CROSSED INGUINAL LYMPHATIC RESCUE FOR PEDIATRIC PATIENTS WITH MIXED LYMPHATIC AND VENOUS MALFORMATIONS

Abstract

Truncular venous malformations and
acquired functional or anatomical venous
occlusions (or sub-occlusions) can be the
cause of secondary lymphedema and even the
cause of primary lymphedema when they are
associated with lymphatic malformations
(lymphangiodysplasia – LAD I, lymphadenodysplasia
– LAD II, or a combination of both)
in pediatric patients. This understanding
recognizes the shared and successive embryogenesis
of both systems. These conditions can
exhibit hypertension in the venous pedicles
intended for lymph-venous anastomosis, and
this finding would be a formal contraindication
to the procedure. However, this
hypertension is a rarely considered condition
and is not commonly identified. As a technique
to solve this problem, we have combined
Nielubowicz, Olszewski, Campisi, and Palma’s
proposals and created a lymph-venous
anastomosis from the side with lymphedema
and venous hypertension (lymphatic donor
and venous recipient) with an internal
suprapubic saphenous venous bridge (from
the normal side to the lymphedematous side
with venous hypertension) to enable a crossed
inguinal lymphatic/venous rescue. We believe
this newly synthesized approach will allow
better clinical care of pediatric patients with
complex and combined lymphatic-venous
malformations and is worthy of further
investigation.