Impaired lymphatic function recovered after great saphenous vein stripping in patients with varicose vein: venodynamic and lymphodynamic results.
OBJECTIVE
Venodynamics and lymphodynamics may interact as an inseparable and mutually dependent dual outflow system. This study investigated the effect of surgical treatment on lower limb lymph flow in patients with varicose veins.


METHODS
Thirty-nine patients with varicose veins in the lower limb (28 patients with unilateral limb, 11 patients with bilateral limb), who demonstrated great saphenous vein reflux, were investigated with air-plethysmography and indocyanine green (ICG) fluorescence lymphography before surgical treatment and 6 months later. Fifteen healthy volunteers participated in this study as a control. With air-plethysmography, venous volume (VV) and venous filling time were measured. Venous filling index (VFI) was calculated. For ICG lymphography, 0.3 mL of ICG (0.5%) was subcutaneously injected at the dorsum of the foot. After the injection, fluorescent image of ICG dye was traced on real-time video images using a near-infrared camera system. The interval until the dye reached the knee was measured (transit time [TT]) in a standing position, which was previously demonstrated to correlate with the interval measured using dynamic isotope lymphoscintigraphy.


RESULTS
In CEAP clinical stage venous disease, TT in patients with C4 approximately 6 and C2 approximately 3 was significantly longer than that in the control group (587 +/- 97 seconds, 484 +/- 82 seconds, 252 +/- 29 seconds, respectively, mean +/- SD, P < .01). Among all limbs with varicose veins, there were correlations between TT and VV (Pearson r = 0.31, P < .01), between TT and VFI (Pearson r = 0.48, P < .01). All patients underwent great saphenous vein stripping. Six months later, the venous clinical severity score significantly improved with significant reductions in both VV and VFI values. TT 6 months postoperatively was also significantly shorter than that before surgical treatment (501 +/- 67 seconds, 340 +/- 38 seconds, respectively, mean +/- SD, P < .01).


CONCLUSIONS
Varicose veins could affect lymphatic function and delay lymphatic flow in the lower limbs. Derangement of lymph flow may correlate with the severity of clinical venous disease and/or the magnitude of venous reflux, which could be reversible with surgical treatment of venous incompetence.
Suzuki
Minoru
M
Division of Vascular Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
Unno
Naoki
N
Yamamoto
Naoto
N
Nishiyama
Motohiro
M
Sagara
Daisuke
D
Tanaka
Hiroki
H
Mano
Yuuki
Y
Konno
Hiroyuki
H
D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D004487:Edema / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D005456:Fluorescent Dyes; D006439:Hemodynamics; D006801:Humans; D007208:Indocyanine Green; D035002:Lower Extremity / Q000098:blood supply*; D008208:Lymphatic System / Q000503:physiopathology*; D008220:Lymphography / Q000379:methods; D008297:Male; D008875:Middle Aged; D010991:Plethysmography; D020127:Recovery of Function; D012501:Saphenous Vein / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014648:Varicose Veins / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000009:adverse effects
D005456:Fluorescent Dyes; D007208:Indocyanine Green