Microsurgical Lymphovenous Anastomosis for the Treatment of Central Lymphatic Flow Disorders in Children and Adults

Central lymphatic flow disorders remain a significant diagnostic and therapeutic challenge. Treatment typically follows a stepwise escalation approach, with reconstructive surgery being employed mainly in patients in whom conservative and interventional methods have failed or are contraindicated. Reconstructive lymphatic surgery, such as thoracic duct-vein anastomosis (TDVA), aims to restore physiological lymphatic drainage by creating a direct connection between the thoracic duct and the venous system. This narrative review summarizes the current evidence on central lymphatic reconstruction and particularly TDVA. Moreover, a general overview of perioperative patient management, diagnostics and alternative non-reconstructive surgical techniques is provided in this review. Several case reports and case series reported successful surgical central lymphatic reconstruction, showing both safety and efficacy of this technique in both acquired and congenital lesions of the central lymphatic system. However, current evidence is limited to small case series, whereas prospective large-scale trials are lacking. Future studies should address optimal patient selection and timing of surgery in addition to conservative and interventional approaches, thus promoting the establishment of evidence-based guidelines for the treatment of central lymphatic disorders.