Objective. A step-by-step description of the developed methods of applying end-to-end and end-to-side lymphovenular anastomoses without the use of vascular clips and a retrospective analysis of the advantages of these techniques.

Material and methods. We have developed step-by-step techniques for end-to-end and end-to-side lymphovenular anastomoses without vascular clips. A retrospective study showed that various variants of lymphovenular anastomoses depend on diameter of the vessel. Despite higher efficiency of side-to-end lymphovenular anastomoses, these ones are possible only in certain ratio of diameters of lymphatic and venous vessels (1:1-1:1.2). Ratio of diameters of lymphatic and venous vessels within 1:1.2-1:1.8 makes it possible to perform end-to-end lymphovenular anastomoses. End-to-side lymphovenular anastomosis is advisable in case of ratio 1:1.9-1:2 and over.

Results. RESULTS Our study showed that side-to-end lymphovenular anastomosis was desirable only in 32.29% of cases, end-to-end anastomosis — 25.78%, end-to-side lymphovenular anastomosis — 41.93%. The developed techniques of end-to-end and end-to-side lymphovenular anastomoses minimize the set of microsurgical instruments required for surgery. End-to-end lymphovenular anastomoses without vascular clips ensure control of venous hypertension in proximal venous segment and exclude retrograde blood flow. Absence of clips simplifies end-to-side lymphovenular anastomosis for junior surgeons.

Keywords. lymphedema, lymphovenular anastomoses, lymphovenular anastomosis technique, end-to-end anastomosis, end-to-side anastomosis, side-to-end anastomosis, without vascular clips