{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T01:12:08Z","timestamp":1792026728252,"version":"4.4.0"},"reference-count":41,"publisher":"Georg Thieme Verlag KG","issue":"05","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background\u2003Breast cancer-related lymphedema is the most common cause of lymphedema in the United States and occurs in up to 50% of individuals receiving axillary lymph node dissection (ALND). Lymphovenous bypass (LVB) at the time of ALND may prevent lymphedema, but long-term results and anastomotic patency are unclear. This study evaluates the feasibility and outcomes of performing immediate lymphatic reconstruction via coupler-assisted bypass (CAB).<\/jats:p><jats:p>\n          Methods\u2003This is a retrospective review of all patients undergoing prophylactic LVB following ALND at two tertiary care centers between 2018 and 2022. Patients were divided into cohorts based on whether they received the \u201cstandard\u201d end-to-end (E-E) suturing or CAB technique. The primary outcome of interest was development of lymphedema. Quantitative and qualitative assessments for lymphedema were performed preoperatively and at 3, 6, 12, and 24 months postoperatively.<\/jats:p><jats:p>\n          Results\u2003Overall, 63 LVBs were performed, of which 24 lymphatics underwent immediate reconstruction via \u201cCAB\u201d and 39 lymphatics via \u201cstandard\u201d end-to-end suture. Patient characteristics, including body mass index, and treatment characteristics, including radiation therapy, did not significantly differ between groups. CAB was associated with a greater mean number of lymphatics bypassed per vein (standard 1.7 vs. CAB 2.6, p\u2009=\u20090.0001) and bypass to larger veins (standard 1.2 vs. CAB 2.2\u2009mm, p\u2009&lt;\u20090.0001). At a median follow-up of 14.7 months, 9.1% (1\/11) of individuals receiving CAB developed lymphedema. These rates were similar to those seen following standard bypass at 4.8% (1\/21), although within a significantly shorter follow-up duration (standard 7.8 vs. CAB 14.7 months, p\u2009=\u20090.0170).<\/jats:p><jats:p>\n          Conclusion\u2003The CAB technique is a viable, effective technical alternative to the standard LVB technique. This comparative study of techniques in prophylactic LVB suggests that CABs maintain long-term patency, possibly due to the ease of anastomosing several lymphatics to single large caliber veins while reducing the technical demands of the procedure.<\/jats:p>","DOI":"10.1055\/a-2181-7559","type":"journal-article","created":{"date-parts":[[2023,9,26]],"date-time":"2023-09-26T23:07:30Z","timestamp":1695769650000},"page":"334-347","source":"Crossref","is-referenced-by-count":6,"title":["Lymphovenous Coupler-Assisted Bypass for Immediate Lymphatic Reconstruction"],"prefix":"10.1055","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1735-5006","authenticated-orcid":false,"given":"Daisy L.","family":"Spoer","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia"},{"name":"Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, Washington, District of Columbia"},{"name":"Department of Plastic and Reconstructive Surgery, MedStar Washington Hospital Center, Washington, District of Columbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5747-0009","authenticated-orcid":false,"given":"Lauren E.","family":"Berger","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia"},{"name":"Plastic & Reconstructive Surgery Division, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Parhom N.","family":"Towfighi","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Pittsburgh Medical Center (UPMC) Mercy Hospital, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romina","family":"Deldar","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nisha","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, Washington, District of Columbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1779-8384","authenticated-orcid":false,"given":"Samuel S.","family":"Huffman","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia"},{"name":"Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, Washington, District of Columbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Banafsheh","family":"Sharif-Askary","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth L.","family":"Fan","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajiv P.","family":"Parikh","sequence":"additional","affiliation":[{"name":"Plastic & Reconstructive Surgery Division, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8216-6957","authenticated-orcid":false,"given":"Laura K.","family":"Tom","sequence":"additional","affiliation":[{"name":"Plastic & Reconstructive Surgery Division, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2024,2,15]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1007\/978-3-319-14493-1_4","volume-title":"Epidemiology and morbidity of lymphedema","author":"A K Greene","year":"2015"},{"issue":"10","key":"ref2","doi-asserted-by":"crossref","first-page":"2972","DOI":"10.1245\/s10434-017-5960-x","article-title":"Breast cancer-related lymphedema risk is related to multidisciplinary treatment and not surgery alone: results from a large cohort study","volume":"24","author":"T T Nguyen","year":"2017","journal-title":"Ann Surg Oncol"},{"issue":"07","key":"ref3","doi-asserted-by":"crossref","first-page":"2546","DOI":"10.3390\/ijms21072546","article-title":"Histopathologic features of lymphedema: a molecular review","volume":"21","author":"C Y Li","year":"2020","journal-title":"Int J Mol Sci"},{"issue":"03","key":"ref4","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1097\/PRS.0000000000005993","article-title":"Surgical treatment of lymphedema","volume":"144","author":"M V Schaverien","year":"2019","journal-title":"Plast Reconstr Surg"},{"key":"ref5","first-page":"666","volume-title":"44 - Lymphedema: Anatomy, Pathophysiology, Evaluation, and Treatment","author":"B J Mehrara","year":"2022"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"S495","DOI":"10.1097\/SAP.0000000000002884","article-title":"The learning curve: trends in the first 100 immediate lymphatic reconstructions performed at a single institution","volume":"86","author":"N K Le","year":"2021","journal-title":"Ann Plast Surg"},{"issue":"03","key":"ref7","doi-asserted-by":"crossref","first-page":"373e","DOI":"10.1097\/PRS.0000000000007636","article-title":"Evaluating the impact of immediate lymphatic reconstruction for the surgical prevention of lymphedema","volume":"147","author":"A R Johnson","year":"2021","journal-title":"Plast Reconstr Surg"},{"issue":"05","key":"ref8","doi-asserted-by":"crossref","first-page":"e4291","DOI":"10.1097\/GOX.0000000000004291","article-title":"Immediate lymphatic reconstruction during axillary node dissection for breast cancer: a systematic review and meta-analysis","volume":"10","author":"W KF Hill","year":"2022","journal-title":"Plast Reconstr Surg Glob Open"},{"issue":"02","key":"ref9","doi-asserted-by":"crossref","first-page":"e3431","DOI":"10.1097\/GOX.0000000000003431","article-title":"Immediate lymphatic reconstruction: technical points and literature review","volume":"9","author":"M Coriddi","year":"2021","journal-title":"Plast Reconstr Surg Glob Open"},{"issue":"08","key":"ref10","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1055\/s-0042-1742730","article-title":"National outcomes of prophylactic lymphovenous bypass during axillary lymph node dissection","volume":"38","author":"S N Chiang","year":"2022","journal-title":"J Reconstr Microsurg"},{"issue":"06","key":"ref11","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1002\/micr.22254","article-title":"Lymphatic microsurgical preventing healing approach (LYMPHA) for primary surgical prevention of breast cancer-related lymphedema: over 4 years follow-up","volume":"34","author":"F Boccardo","year":"2014","journal-title":"Microsurgery"},{"issue":"01","key":"ref12","doi-asserted-by":"crossref","first-page":"92","DOI":"10.3390\/jcm11010092","article-title":"Lymphatic Microsurgical Preventive Healing Approach (LYMPHA) for lymphedema prevention after axillary lymph node dissection-a single institution experience and feasibility of technique","volume":"11","author":"K Lipman","year":"2021","journal-title":"J Clin Med"},{"issue":"03","key":"ref13","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1245\/s10434-008-0270-y","article-title":"Lymphedema microsurgical preventive healing approach: a new technique for primary prevention of arm lymphedema after mastectomy","volume":"16","author":"F Boccardo","year":"2009","journal-title":"Ann Surg Oncol"},{"issue":"09","key":"ref14","doi-asserted-by":"crossref","first-page":"2459","DOI":"10.1245\/s10434-009-0554-x","article-title":"Feasibility of axillary reverse mapping during sentinel lymph node biopsy in breast cancer patients","volume":"16","author":"F Casabona","year":"2009","journal-title":"Ann Surg Oncol"},{"issue":"03","key":"ref15","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1007\/s13193-018-0731-0","article-title":"Lymphatic Microsurgical Preventing Healing Approach (LYMPHA) for prevention of breast cancer-related lymphedema-a preliminary report","volume":"9","author":"J Agrawal","year":"2018","journal-title":"Indian J Surg Oncol"},{"issue":"02","key":"ref16","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1002\/jso.25513","article-title":"Axillary reverse mapping and lymphaticovenous bypass: lymphedema prevention through enhanced lymphatic visualization and restoration of flow","volume":"120","author":"G S Schwarz","year":"2019","journal-title":"J Surg Oncol"},{"issue":"10","key":"ref17","doi-asserted-by":"crossref","first-page":"3296","DOI":"10.1245\/s10434-015-4721-y","article-title":"Single institution experience with Lymphatic Microsurgical Preventive Healing Approach (LYMPHA) for the primary prevention of lymphedema","volume":"22","author":"S Feldman","year":"2015","journal-title":"Ann Surg Oncol"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1016\/j.jss.2017.10.008","article-title":"A lymphedema surveillance program for breast cancer patients reveals the promise of surgical prevention","volume":"244","author":"M Hahamoff","year":"2019","journal-title":"J Surg Res"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"S234","DOI":"10.1097\/SAP.0000000000001864","article-title":"Lymphedema incidence after axillary lymph node dissection: quantifying the impact of radiation and the lymphatic microsurgical preventive healing approach","volume":"82","author":"A R Johnson","year":"2019","journal-title":"Ann Plast Surg"},{"issue":"09","key":"ref20","doi-asserted-by":"crossref","first-page":"2500","DOI":"10.1245\/s10434-011-1624-4","article-title":"Surgical prevention of arm lymphedema after breast cancer treatment","volume":"18","author":"F M Boccardo","year":"2011","journal-title":"Ann Surg Oncol"},{"issue":"11","key":"ref21","doi-asserted-by":"crossref","first-page":"3558","DOI":"10.1245\/s10434-016-5282-4","article-title":"LYMPHA technique to prevent secondary lower limb lymphedema","volume":"23","author":"F Boccardo","year":"2016","journal-title":"Ann Surg Oncol"},{"issue":"08","key":"ref22","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.1002\/jso.25902","article-title":"An economic analysis of prophylactic lymphovenous anastomosis among breast cancer patients receiving mastectomy with axillary lymph node dissection","volume":"121","author":"L Squitieri","year":"2020","journal-title":"J Surg Oncol"},{"issue":"04","key":"ref23","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1055\/s-0039-3401829","article-title":"Lymphaticovenous bypass for immediate lymphatic reconstruction in locoregional advanced melanoma patients","volume":"36","author":"C Cakmakoglu","year":"2020","journal-title":"J Reconstr Microsurg"},{"issue":"02","key":"ref24","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1097\/PRS.0000000000009857","article-title":"Lymphatic Microsurgical Preventive Healing Approach (LYMPHA) for the primary prevention of lymphedema: a 4-year follow-up matched cohort study","volume":"151","author":"A S Levy","year":"2023","journal-title":"Plast Reconstr Surg"},{"issue":"05","key":"ref25","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1016\/j.bjps.2020.01.012","article-title":"Lymphovenous anastomosis using the venous coupler","volume":"73","author":"G C Sisk","year":"2020","journal-title":"J Plast Reconstr Aesthet Surg"},{"key":"ref26","first-page":"43","article-title":"Recent advancements in supermicrosurgical treatment of lymphedema","volume":"8","author":"S Jabbour","year":"2021","journal-title":"Plastic and Aesthetic Research"},{"issue":"02","key":"ref27","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1016\/j.bjps.2014.10.013","article-title":"Never fear the venous-lymphatic coupler is here!","volume":"68","author":"P Sharma","year":"2015","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"05","key":"ref28","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: development and validation","volume":"40","author":"M E Charlson","year":"1987","journal-title":"J Chronic Dis"},{"issue":"02","key":"ref29","first-page":"85","article-title":"L-dex ratio in detecting breast cancer-related lymphedema: reliability, sensitivity, and specificity","volume":"46","author":"M R Fu","year":"2013","journal-title":"Lymphology"},{"issue":"04","key":"ref30","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1097\/SLA.0000000000005671","article-title":"Impact of axillary lymph node dissection and sentinel lymph node biopsy on upper limb morbidity in breast cancer patients: a systematic review and meta-analysis","volume":"277","author":"N A Che Bakri","year":"2023","journal-title":"Ann Surg"},{"issue":"01","key":"ref31","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1111\/j.1524-4741.2009.00855.x","article-title":"Obesity is a risk factor for developing postoperative lymphedema in breast cancer patients","volume":"16","author":"L K Helyer","year":"2010","journal-title":"Breast J"},{"issue":"02","key":"ref32","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1093\/jnci\/93.2.96","article-title":"Arm edema in breast cancer patients","volume":"93","author":"V S Erickson","year":"2001","journal-title":"J Natl Cancer Inst"},{"issue":"06","key":"ref33","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1016\/S1470-2045(13)70076-7","article-title":"Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis","volume":"14","author":"T DiSipio","year":"2013","journal-title":"Lancet Oncol"},{"issue":"05","key":"ref34","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1007\/s12282-020-01088-x","article-title":"Risk factors for breast cancer-related lymphedema: correlation with docetaxel administration","volume":"27","author":"Y Aoishi","year":"2020","journal-title":"Breast Cancer"},{"issue":"02","key":"ref35","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1097\/PRS.0000000000009857","article-title":"Lymphatic Microsurgical Preventive Healing Approach for the Primary Prevention of Lymphedema: A 4-Year Follow-Up","volume":"151","author":"A S Levy","year":"2023","journal-title":"Plast Reconstr Surg"},{"issue":"06","key":"ref36","doi-asserted-by":"crossref","first-page":"1407","DOI":"10.1097\/PRS.0000000000003354","article-title":"Comparison of lymphovenous shunt methods in a rat model: supermicrosurgical lymphaticovenular anastomosis versus microsurgical lymphaticovenous implantation","volume":"139","author":"R Ishiura","year":"2017","journal-title":"Plast Reconstr Surg"},{"key":"ref37","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.jss.2021.08.012","article-title":"Relationship between lymphaticovenular anastomosis outcomes and the number and types of anastomoses","volume":"269","author":"S Onoda","year":"2022","journal-title":"J Surg Res"},{"key":"ref38","volume-title":"Netter's Essential Physiology","author":"S E Mulroney","year":"2016"},{"issue":"04","key":"ref39","doi-asserted-by":"crossref","first-page":"e4267","DOI":"10.1097\/GOX.0000000000004267","article-title":"\u201cDouble Barrel\u201d lymphaticovenous anastomosis: a useful addition to a supermicrosurgeon's repertoire","volume":"10","author":"Z Masoodi","year":"2022","journal-title":"Plast Reconstr Surg Glob Open"},{"issue":"01","key":"ref40","first-page":"42","article-title":"A single-site technique of multiple lymphatic-venous anastomoses for the treatment of peripheral lymphedema: long-term clinical outcome","volume":"32","author":"C C Campisi","year":"2016","journal-title":"J Reconstr Microsurg"},{"issue":"06","key":"ref41","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1055\/s-0035-1548746","article-title":"The \u201cOctopus\u201d lymphaticovenular anastomosis: evolving beyond the standard supermicrosurgical technique","volume":"31","author":"W F Chen","year":"2015","journal-title":"J Reconstr Microsurg"}],"container-title":["Journal of Reconstructive Microsurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2181-7559.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,5]],"date-time":"2024-11-05T16:30:22Z","timestamp":1730824222000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2181-7559"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,26]]},"references-count":41,"journal-issue":{"issue":"05","published-online":{"date-parts":[[2024,5,6]]},"published-print":{"date-parts":[[2024,6]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2181-7559","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0743-684X","1098-8947"],"issn-type":[{"value":"0743-684X","type":"print"},{"value":"1098-8947","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,9,26]]},"published":{"date-parts":[[2023,9,26]]}}}