title: Lower limb lymphedema treated with lymphatico-venous anastomosis based on pre- and intraoperative icg lymphography and non-contact vein visualization: A case report.
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.
authors.affiliation: Department of Plastic and Reconstructive Surgery, University of Tokyo, Japan. mihara@keiseigeka.name
authors.forename: Makoto
authors.initials: M
authors.lastname: Mihara
authors.forename: Hisako
authors.initials: H
authors.lastname: Hara
authors.forename: Mitsunaga
authors.initials: M
authors.lastname: Narushima
authors.forename: Yohei
authors.initials: Y
authors.lastname: Hayashi
authors.forename: Takumi
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Azusa
authors.initials: A
authors.lastname: Oshima
authors.forename: Kazuki
authors.initials: K
authors.lastname: Kikuchi
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Murai
authors.forename: Isao
authors.initials: I
authors.lastname: Koshima
mesh_terms: D000714:Anastomosis, Surgical; D004396:Coloring Agents; D005260:Female; D006801:Humans; D007208:Indocyanine Green; D007866:Leg; D042601:Lymphatic Vessels / Q000000981:diagnostic imaging / Q000601:surgery*; D008209:Lymphedema / Q000000981:diagnostic imaging / Q000601:surgery*; D008220:Lymphography; D008875:Middle Aged; D014680:Veins / Q000601:surgery
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green