Double Barrel Lymphaticovenular Anastomosis

With improvements in the super-micro surgical technique, lymphaticovenular anastomosis (LVA) has become an effective treatment for obstructive lymph edema1. Recently, indocyanine green (ICG) dye lymphography makes it possible to visualize lymph vessels. LVA requires specific veins in the field. However veins come in a variety of sizes, and options for anastomosis i.e. end to end, end to side and side to end are chosen to deal with the discrepancies between lymph vessels and veins2. On the other hand, lymph vessels are sometimes bunched.

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