title: Use of Indocyanine Green-SPY Angiography for Tracking Lymphatic Recovery After Lymphaticovenous Anastomosis.
abstract: BACKGROUND
  Lymphaticovenous anastomosis (LVA) is a surgical treatment option for patients with early stage lymphedema. To date, no ideal imaging modality exists for tracking patency of the LVA postoperatively. We hypothesize that laser angiography utilizing indocyanine green (ICG) via the SPY system (Lifecell Corp.) would be a useful methodology for assessing the patency of the LVA and lymphatic recovery postoperatively.
  
  
  METHODS
  A prospective trial was performed on patients with stage II lymphedema who underwent LVA from 2013 to 2014 by a single surgeon. All candidates underwent preoperative and postoperative lymphatic mapping using ICG-SPY angiography. Postoperative analyses were performed at 1 month and at 9 months after surgery and assessed for patency at the site of the LVAs and for changes in lymphatic pattern.
  
  
  RESULTS
  Five patients underwent LVA, 3 for upper extremity and 2 for lower extremity stage II lymphedema. The number of LVAs per extremity was 1 to 3 (total, 11). One month postoperative ICG-SPY angiography demonstrated flow through 9 of 11 anastomoses. Evaluation at 9 months postoperative showed improvement in lymphatic drainage.
  
  
  CONCLUSIONS
  Indocyanine green-SPY angiography may be used to objectively evaluate the surgical outcome of LVA.
authors.affiliation: From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford Hospital and Clinics, Stanford, CA.
authors.forename: Hubert B
authors.initials: HB
authors.lastname: Shih
authors.forename: Afaaf
authors.initials: A
authors.lastname: Shakir
authors.forename: Dung H
authors.initials: DH
authors.lastname: Nguyen
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D005260:Female; D005456:Fluorescent Dyes; D005500:Follow-Up Studies; D006801:Humans; D007208:Indocyanine Green; D042601:Lymphatic Vessels / Q000000981:diagnostic imaging / Q000601:surgery*; D008209:Lymphedema / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D061848:Optical Imaging / Q000379:methods*; D011446:Prospective Studies; D016896:Treatment Outcome; D014699:Venules / Q000000981:diagnostic imaging / Q000601:surgery*
chemical_list: D005456:Fluorescent Dyes; D007208:Indocyanine Green