The Venous Coupler in Lymphovenous Anastomosis: Review of the Literature and Clinical Experience

Peripheral lymphedema is a chronic and progressive condition characterized by impaired lymphatic drainage, leading to fluid accumulation, tissue fibrosis and significant deterioration in quality of life. Lymphovenous anastomosis (LVA) has emerged as a physiological supermicrosurgical technique that diverts lymphatic flow into the venous system and is increasingly used for both the treatment and prevention of secondary lymphedema. However, the procedure remains technically demanding because of the small caliber and fragility of lymphatic vessels. Venous coupler devices, which are widely used in microvascular surgery for sutureless venous anastomoses, may represent a useful adjunct to simplify lymphovenous connections and improve surgical reproducibility. Currently, no coupler devices have been specifically designed or approved for LVA, and their use in this context remains off-label. This clinical practice review summarizes the current literature on the use of venous couplers in LVA and presents the authors’ institutional experience with coupler-assisted lymphovenous anastomosis performed as part of immediate lymphatic reconstruction in oncologic patients. Published reports demonstrate the feasibility of this technique and suggest potential advantages including reduced anastomosis time, improved intimal alignment, and minimal intraluminal foreign material. In our institutional cohort of 33 patients undergoing coupler-assisted LVA, no cases of postoperative lymphedema were observed during a mean follow-up of 12.7 months, and no device-related complications occurred. Venous coupler–assisted LVA appears to be a safe and efficient adjunct in lymphatic reconstruction that may facilitate broader adoption of prophylactic LVA in oncologic surgery; however, larger studies with longer follow-up are required to confirm long-term outcomes and patency.