{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T01:12:06Z","timestamp":1792026726717,"version":"4.4.0"},"reference-count":39,"publisher":"Georg Thieme Verlag KG","issue":"03","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Central lymphatic disruption can result in devastating lymphedema, chylothorax, chylous ascites, metabolic deficiencies, and death. Literature from our institution has previously demonstrated the technical feasibility of lymphovenous anastomosis (LVA) for thoracic duct (TD) bypass. Here, we present our complete patient series with expanded follow-up utilizing a microsurgical venous coupler to facilitate LVA.<\/jats:p>\n                  <jats:p>A single-institution, retrospective review was conducted for adult patients who underwent LVA for TD bypass between 2019 and 2024. Demographic, etiological, and perioperative information was collected. Symptomatic resolution with or without radiographically confirmed patency was considered a successful bypass at follow-up.<\/jats:p>\n                  <jats:p>A total of 23 patients underwent LVA of the TD. The mean age was 49.7 years. Median postoperative follow-up was 395 days (interquartile range [IQR]: 150.5\u2013554.5). Anastomotic targets included the EJV (n\u2009=\u200915), IJV (n\u2009=\u20094), AJV (n\u2009=\u20092), or another regional vein (n\u2009=\u20093). The technical success of the venous coupler was 100%. Three patients experienced a surgical site complication (13.0%). At follow-up, 13 patients (56.5%) had a patent TD anastomosis with symptomatic resolution. One patient (4.3%) had a patent anastomosis confirmed on imaging but experienced mild symptomatic recrudescence. The remaining patients (39.1%) had nonpatent anastomoses. The median venous coupler size was 3.0\u2009mm for both the patent cohort and the nonpatent cohort.<\/jats:p>\n                  <jats:p>LVA for TD bypass with an anastomotic coupler is well tolerated and provided durable relief of symptoms in over half of our cohort. This data supports venous coupler utilization in LVA for thoracic TD occlusion. Patient accrual is ongoing to further evaluate and optimize outcomes.<\/jats:p>","DOI":"10.1055\/a-2596-5270","type":"journal-article","created":{"date-parts":[[2025,4,29]],"date-time":"2025-04-29T19:26:28Z","timestamp":1745954788000},"page":"181-188","source":"Crossref","is-referenced-by-count":3,"title":["Efficacy of Microsurgical Venous Couplers in Lymphovenous Anastomosis of the Thoracic Duct: An Examination of Outcomes and Patency at Follow-Up"],"prefix":"10.1055","volume":"42","author":[{"given":"Dustin T.","family":"Crystal","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zachary","family":"Gala","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Selma","family":"Brkic","sequence":"additional","affiliation":[{"name":"Intensive Care Nurse, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robyn","family":"Broach","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Said C.","family":"Azoury","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maxim","family":"Itkin","sequence":"additional","affiliation":[{"name":"Section of Interventional Radiology, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen J.","family":"Kovach","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,5,22]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1146\/annurev.cellbio.21.012704.132338","article-title":"The lymphatic vasculature: recent progress and paradigms","volume":"21","author":"G Oliver","year":"2005","journal-title":"Annu Rev Cell Dev Biol"},{"issue":"01","key":"ref2","doi-asserted-by":"crossref","first-page":"105","DOI":"10.14218\/JCTH.2017.00035","article-title":"Chylous ascites: a review of pathogenesis, diagnosis and treatment","volume":"6","author":"R Bhardwaj","year":"2018","journal-title":"J Clin Transl Hepatol"},{"issue":"06","key":"ref3","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1038\/s41568-024-00681-y","article-title":"Lymphatic vessels in the age of cancer immunotherapy","volume":"24","author":"T Karakousi","year":"2024","journal-title":"Nat Rev Cancer"},{"issue":"1016","key":"ref4","doi-asserted-by":"crossref","first-page":"1052","DOI":"10.1259\/bjr\/19379150","article-title":"Thoracic duct and cisterna chyli: evaluation with multidetector row CT","volume":"85","author":"M Kiyonaga","year":"2012","journal-title":"Br J Radiol"},{"issue":"06","key":"ref5","doi-asserted-by":"crossref","first-page":"1146","DOI":"10.1111\/joa.13167","article-title":"Anatomy of the lymphovenous valve of the thoracic duct in humans","volume":"236","author":"L A O'Hagan","year":"2020","journal-title":"J Anat"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1146\/annurev-fluid-122316-045259","article-title":"Lymphatic system flows","volume":"50","author":"J E Moore Jr","year":"2018","journal-title":"Annu Rev Fluid Mech"},{"issue":"04","key":"ref7","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1177\/1457496920987076","article-title":"Prolonged iatrogenic thoracic duct chylous fistula in neck surgery: conservative management or surgery? A literature review","volume":"110","author":"D Parmeggiani","year":"2021","journal-title":"Scand J Surg"},{"issue":"S 01","key":"ref8","doi-asserted-by":"crossref","first-page":"115S","DOI":"10.1177\/2192568216688194","article-title":"Thoracic duct injury following cervical spine surgery: a multicenter retrospective review","volume":"7","author":"A Derakhshan","year":"2017","journal-title":"Global Spine J"},{"issue":"01","key":"ref9","doi-asserted-by":"publisher","DOI":"10.4103\/jctt.jctt_19_21","article-title":"Thoracic duct injury: an up to date","volume":"6","author":"J L Ruiz Pier","year":"2021","journal-title":"J Cardiothorac Trauma"},{"issue":"02","key":"ref10","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1016\/j.thorsurg.2011.01.002","article-title":"Anatomy of the thoracic duct","volume":"21","author":"H Hematti","year":"2011","journal-title":"Thorac Surg Clin"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"3","DOI":"10.21037\/med-20-64","article-title":"Review of chylopericardium","volume":"6","author":"M M Rochefort","year":"2022","journal-title":"Mediastinum"},{"issue":"05","key":"ref12","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1053\/j.sempedsurg.2014.09.011","article-title":"Chylothorax and chylous ascites: management and pitfalls","volume":"23","author":"J C Lopez-Gutierrez","year":"2014","journal-title":"Semin Pediatr Surg"},{"issue":"01","key":"ref13","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1016\/j.amjsurg.2015.04.012","article-title":"Treatment options for chylous ascites after major abdominal surgery: a systematic review","volume":"211","author":"M Weniger","year":"2016","journal-title":"Am J Surg"},{"issue":"01","key":"ref14","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.rmed.2009.08.010","article-title":"Chylothorax: aetiology, diagnosis and therapeutic options","volume":"104","author":"E E McGrath","year":"2010","journal-title":"Respir Med"},{"issue":"11","key":"ref15","doi-asserted-by":"crossref","first-page":"1442","DOI":"10.1046\/j.0007-1323.2001.01896.x","article-title":"Management of thoracic duct injuries after oesophagectomy","volume":"88","author":"S A Wemyss-Holden","year":"2001","journal-title":"Br J Surg"},{"issue":"03","key":"ref16","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1002\/ncp.10973","article-title":"Chylothorax and chylous ascites: overview, management, and nutrition","volume":"38","author":"N T Duletzke","year":"2023","journal-title":"Nutr Clin Pract"},{"issue":"03","key":"ref17","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1007\/s00270-017-1856-1","article-title":"Lymphangiography and lymphatic embolization for the treatment of refractory chylous ascites","volume":"41","author":"G J Nadolski","year":"2018","journal-title":"Cardiovasc Intervent Radiol"},{"issue":"04","key":"ref18","doi-asserted-by":"crossref","first-page":"658e","DOI":"10.1097\/PRS.0000000000007419","article-title":"Update on liposuction: what all plastic surgeons should know","volume":"147","author":"O E Beidas","year":"2021","journal-title":"Plast Reconstr Surg"},{"issue":"04","key":"ref19","doi-asserted-by":"crossref","first-page":"1003e","DOI":"10.1097\/PRS.0000000000003218","article-title":"Current concepts in the surgical management of lymphedema","volume":"139","author":"T A Kung","year":"2017","journal-title":"Plast Reconstr Surg"},{"issue":"05","key":"ref20","doi-asserted-by":"crossref","first-page":"1305","DOI":"10.1097\/PRS.0b013e3182a4d626","article-title":"A prospective analysis of 100 consecutive lymphovenous bypass cases for treatment of extremity lymphedema","volume":"132","author":"D W Chang","year":"2013","journal-title":"Plast Reconstr Surg"},{"issue":"06","key":"ref21","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1055\/s-2006-947150","article-title":"Supermicrosurgical lymphaticovenular anastomosis for the treatment of lymphedema in the upper extremities","volume":"16","author":"I Koshima","year":"2000","journal-title":"J Reconstr Microsurg"},{"issue":"02","key":"ref22","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1097\/PRS.0000000000002395","article-title":"Long-term patency of lymphovenous anastomoses: a systematic review","volume":"138","author":"S S Tourani","year":"2016","journal-title":"Plast Reconstr Surg"},{"issue":"03","key":"ref23","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1016\/j.jvs.2011.08.062","article-title":"Outcomes of lymphaticovenous side-to-end anastomosis in peripheral lymphedema","volume":"55","author":"J Maegawa","year":"2012","journal-title":"J Vasc Surg"},{"issue":"01","key":"ref24","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1016\/j.jvsv.2018.05.030","article-title":"Evaluation of patency rates of different lymphaticovenous anastomosis techniques and risk factors for obstruction in secondary upper extremity lymphedema","volume":"7","author":"Y Suzuki","year":"2019","journal-title":"J Vasc Surg Venous Lymphat Disord"},{"issue":"10","key":"ref25","doi-asserted-by":"crossref","first-page":"e15258","DOI":"10.14814\/phy2.15258","article-title":"Spontaneous contractions of the human thoracic duct-Important for securing lymphatic return during positive pressure ventilation?","volume":"10","author":"B Kelly","year":"2022","journal-title":"Physiol Rep"},{"issue":"03","key":"ref26","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1016\/j.jpedsurg.2018.08.056","article-title":"Lymphaticovenous bypass of the thoracic duct for the treatment of chylous leak in central conducting lymphatic anomalies","volume":"54","author":"A H Taghinia","year":"2019","journal-title":"J Pediatr Surg"},{"issue":"02","key":"ref27","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1016\/j.jpedsurg.2019.10.029","article-title":"Thoracic duct-to-vein anastomosis for the management of thoracic duct outflow obstruction in newborns and infants: a case series","volume":"55","author":"B Reisen","year":"2020","journal-title":"J Pediatr Surg"},{"issue":"12","key":"ref28","doi-asserted-by":"crossref","first-page":"e4695","DOI":"10.1097\/GOX.0000000000004695","article-title":"Thoracic duct lymphovenous bypass: a preliminary case series, surgical techniques, and expected physiologic outcomes","volume":"10","author":"Y Toyoda","year":"2022","journal-title":"Plast Reconstr Surg Glob Open"},{"issue":"03","key":"ref29","doi-asserted-by":"crossref","first-page":"792","DOI":"10.1097\/PRS.0b013e3181cb636d","article-title":"1000 consecutive venous anastomoses using the microvascular anastomotic coupler in breast reconstruction","volume":"125","author":"S Jandali","year":"2010","journal-title":"Plast Reconstr Surg"},{"issue":"02","key":"ref30","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1097\/SAP.0b013e31825c07a1","article-title":"Lower extremity free flap outcomes using an anastomotic venous coupler device","volume":"72","author":"N D Medina","year":"2014","journal-title":"Ann Plast Surg"},{"issue":"10","key":"ref31","doi-asserted-by":"crossref","first-page":"e3875","DOI":"10.1097\/GOX.0000000000003875","article-title":"Microsurgical thoracic duct lymphovenous bypass in the adult population","volume":"9","author":"S Othman","year":"2021","journal-title":"Plast Reconstr Surg Glob Open"},{"issue":"02","key":"ref32","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1016\/j.jpedsurg.2023.10.039","article-title":"Surgical management of central lymphatic conduction disorders: a review","volume":"59","author":"P Laje","year":"2024","journal-title":"J Pediatr Surg"},{"issue":"08","key":"ref33","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1056\/NEJMra2301594","article-title":"Protein-losing enteropathy","volume":"389","author":"A Ozen","year":"2023","journal-title":"N Engl J Med"},{"issue":"01","key":"ref34","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1038\/ajg.2009.561","article-title":"Protein-losing enteropathy: case illustrations and clinical review","volume":"105","author":"S B Umar","year":"2010","journal-title":"Am J Gastroenterol"},{"key":"ref35","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1016\/j.suronc.2020.09.005","article-title":"Epidemiology of lymphedema-related admissions in the United States: 2012-2017","volume":"35","author":"M Lopez","year":"2020","journal-title":"Surg Oncol"},{"issue":"06","key":"ref36","doi-asserted-by":"crossref","first-page":"1131e","DOI":"10.1097\/PRS.0000000000010965","article-title":"Optimizing outcomes in lymphedema reconstruction","volume":"152","author":"R M Garza","year":"2023","journal-title":"Plast Reconstr Surg"},{"issue":"03","key":"ref37","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1055\/s-0035-1563737","article-title":"Venous thrombosis in handsewn versus coupled venous anastomoses in 857 consecutive breast free flaps","volume":"32","author":"A R Kulkarni","year":"2016","journal-title":"J Reconstr Microsurg"},{"issue":"01","key":"ref38","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1007\/s10549-019-05450-2","article-title":"Correlation between patency and clinical improvement after lymphaticovenous anastomosis (LVA) in breast cancer-related lymphedema: 12-month follow-up","volume":"179","author":"J AGN Wolfs","year":"2020","journal-title":"Breast Cancer Res Treat"},{"issue":"07","key":"ref39","doi-asserted-by":"crossref","first-page":"668","DOI":"10.1002\/micr.30944","article-title":"Long-term patency of multiple lymphatic-venous anastomoses in cancer-related lymphedema: a single center observational study","volume":"42","author":"F Boccardo","year":"2022","journal-title":"Microsurgery"}],"container-title":["Journal of Reconstructive Microsurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2596-5270.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T00:06:08Z","timestamp":1771373168000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2596-5270"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,29]]},"references-count":39,"journal-issue":{"issue":"03","published-online":{"date-parts":[[2026,2,17]]},"published-print":{"date-parts":[[2026,3]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2596-5270","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":[[2025,4,29]]},"published":{"date-parts":[[2025,4,29]]}}}