title: Intraoperative lymph mapping with preoperative vein mapping to prevent postoperative lymphorrhea following paramalleolar bypass surgery in patients with critical limb ischemia.
abstract: OBJECTIVE
  Paramalleolar bypass surgery requires a long incision to harvest the great saphenous vein (GSV), which is often associated with intractable postoperative lymphorrhea. To prevent this complication, we developed a novel method of intraoperative lymph imaging and preoperative vein mapping for vein harvesting.
  
  
  METHODS
  Thirteen consecutive patients with critical limb ischemia (CLI) underwent both preoperative vein mapping and intraoperative lymph mapping (Group A). Duplex vein mapping was performed to mark the GSV. Lymph mapping was performed with indocyanine green fluorescence lymphography. Paramalleolar bypasses were performed using reversed GSV grafts, with careful ligation of the subcutaneous lymph collector vessels above the GSV. The development of intractable postoperative lymphorrhea and the length of the postoperative hospital stay were compared with those in the previous ten consecutive CLI patients without lymph mapping who underwent paramalleolar bypass (Group B).
  
  
  RESULTS
  The occurrence of intractable wound lymphorrhea by the 30th postoperative day was 3/10 (30 %) in Group B, while it was 0/13 (0 %) in Group A (p < 0.05). The length of the postoperative hospital stay was 31.7 ± 8.8 and 57.5 ± 39.5 days (Group A and Group B, respectively, p < 0.05).
  
  
  CONCLUSIONS
  Intraoperative lymph mapping and preoperative vein mapping are technically feasible and can positively contribute to the prevention of postoperative lymphorrhea after GSV harvesting.
authors.affiliation: Division of Vascular Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan, unno@hama-med.ac.jp.
authors.forename: Naoki
authors.initials: N
authors.lastname: Unno
authors.forename: Naoto
authors.initials: N
authors.lastname: Yamamoto
authors.forename: Minoru
authors.initials: M
authors.lastname: Suzuki
authors.forename: Hiroki
authors.initials: H
authors.lastname: Tanaka
authors.forename: Yuuki
authors.initials: Y
authors.lastname: Mano
authors.forename: Masaki
authors.initials: M
authors.lastname: Sano
authors.forename: Takaaki
authors.initials: T
authors.lastname: Saito
authors.forename: Ryota
authors.initials: R
authors.lastname: Sugisawa
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Konno
mesh_terms: D000368:Aged; D001157:Arterial Occlusive Diseases / Q000150:complications; D005260:Female; D006801:Humans; D007208:Indocyanine Green; D007432:Intraoperative Period; D007511:Ischemia / Q000209:etiology / Q000601:surgery*; D007902:Length of Stay; D035002:Lower Extremity / Q000098:blood supply*; D008206:Lymphatic Diseases / Q000517:prevention & control*; D008220:Lymphography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000150:complications; D011183:Postoperative Complications / Q000517:prevention & control*; D057234:Preoperative Period; D012501:Saphenous Vein / Q000601:surgery* / Q000637:transplantation*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D020858:Tissue and Organ Harvesting / Q000379:methods*; D058017:Vascular Grafting / Q000379:methods*; D014656:Vascular Surgical Procedures / Q000379:methods*
chemical_list: D007208:Indocyanine Green