Lower limb lymphedema treated with lymphatico-venous anastomosis based on pre- and intraoperative icg lymphography and non-contact vein visualization: A case report.

Mar 2012

Mihara M, Hara H, Narushima M, Hayashi Y, Yamamoto T, Oshima A, Kikuchi K, Murai N, Koshima I.

Source

Department of Plastic and Reconstructive Surgery, University of Tokyo, Japan. mihara@keiseigeka.name

Abstract

Lymphatico-venous anastomosis (LVA) is used to resolve lymph retention in lymphedema. However, the postoperative outcome of lower limb lymphedema is poorer than that for upper limb lymphedema, because of the location lower than the heart level. Improvement of the therapeutic outcome requires application of as many anastomoses as possible in a limited operation time, particularly since there is a positive correlation between the number of anastomoses and the therapeutic effect of LVA. In this case, we described a method to increase the efficiency of lymphatico-venous anastomosis for bilateral severe lower limb lymphedema through efficient identification of lymph vessels and veins suitable for anastomosis using indocyanine green (ICG) contrast imaging and AccuVein, a noncontact vein visualization system, respectively. Ten LVAs were succeeded at seven incisions, and the operation time was 3 hours and 5 minutes. Accuvein can be used for identification of subcutaneous venules with a diameter of about 0.5-1.0 mm. We used this approach in surgery for a case of bilateral lower limb lymphedema, with a resultant improvement in the surgical outcome.

Wiley Online

Regional diagnosis of lymphoedema and selection of sites for lymphaticovenular anastomosis using elastography.

Aug 2011

Mihara M, Hayashi Y, Murai N, Moriguchi H, Iida T, Hara H, Todokoro T, Narushima M, Uchida G, Koshima I.

Source

Department of Plastic Surgery and Reconstructive Surgery, The University of Tokyo, Tokyo 113-8655, Japan. mihara@keiseigeka.name

Abstract

AIM:

To evaluate the use of ultrasound elastography as a basis for determining the most appropriate sites for lymphaticovenular anastomosis (LVA) for treatment of lymphoedema.

MATERIALS AND METHODS:

Preoperative elastography and LVA were performed in 11 patients (11 legs) with leglymphoedema, including two cases of primary oedema and nine of secondary oedema.

RESULTS:

The mean number of LVAs applied per leg was 4.4 (range 3-7). The mean reduction in the leg circumference was 91.7%, and 10 of the 11 cases (90.0%) were improved. Hardness was reduced from a mean of 1.6 before surgery to 0.9 after surgery, and improvement was also noted in 10 cases (90.9%). The severity of oedema was determined in five regions in each leg, and was classified as elastography stage (ES) 0 in 11 regions, ES1 in 23, ES2 in 15, and ES3 in six.

CONCLUSIONS:

These results demonstrate the value of ultrasound elastography for the diagnosis of early-stagelymphoedema and determination of LVA sites. This is the first report of diagnosis of lymphoedema using elastography and the findings suggest that this procedure followed by LVA could be used as a new therapeutic method for early-stage lymphoedema.

ElsevierSciVerse