Split intravascular stents for side-to-end lymphaticovenular anastomosis.

Supermicrosurgical lymphaticovenular anastomosis (LVA) is becoming the treatment of choice for compression-refractory lymphedema. Among various types of LVA, side-to-end (S-E) LVA is considered to be the most efficient one, because it can divert bidirectional lymph flows into venous circulation via 1 anastomosis, but is technically difficult. We developed a new technique for safe and easy S-E LVA with modified intravascular stenting (IVaS) method. Different from the original IVaS method, a lymphatic vessel is pierced by an IVaS before creation of a lateral window. The IVaS is cut after window creation and the ends are inserted into the lymphatic vessel and the venule respectively, guiding the course of the needle throughout the S-E anastomosis procedure. This method makes S-E LVA easier without special instruments.