Preoperative Planning for Lymphaticovenous Anastomosis with Indocyanine Green Lymphography and Magnetic Resonance Lymphangiography
Laura K. Tom, MD, Xavier Alomar, MD, Juan Carlos Clavero, MD, Jaume MasiÓ, MD, PhD, Gemma Pons i PlayÓ, MD, PhD.
Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
PURPOSE: Lymphedema is a progressive disease caused by insufficient lymphatic drainage. Supermicrosurgery techniques have allowed for intervention at the lymphatic level including lymphaticovenular anastomosis (LVA). To perform LVAs, the lymphatic vessel must be identified. The most common imaging modalities are indocyanine green lymphography (ICG-L) and magnetic resonance lymphangiography (MRL). The goal of this study was to evaluate how ICG-L and MRL findings confer to successful LVA in patients with lymphedema.
METHODS: Prospective data was collected from June 2010 to June 2015 at a single institution. Lymphedema patients with functional lymphatics identified with ICG-L were included. MRL was completed within one month of the surgery. Preoperatively, MRL mapping was transferred to the limb and ICG-L repeated. The sites with imaging concordance of lymphatics were prioritized for LVA.
RESULTS: A total of 86 extremities (60% upper extremities) were included (82 patients, 4 with bilateral lymphedema). Most patients had secondary lymphedema (74%) and were classified as stage II (73%). Overall, lymphatic vessels were identified in 82.6% and satisfactory LVAs were performed in 73.3% (no LVA - no regional vein (9.3%) or no identifiable lymphatic (17.4%)). Preoperative imaging concordance with ICG-L and MRL was 33.9%. In these prioritized locals, 91.4% underwent satisfactory LVA (no LVA no regional vein (5.5%) or no identifiable lymphatic (3.1%)). CONCLUSION: Although ICG-L and MRL are inherently different, using their imaging concordance for LVA has a high rate of success. Following these patients' outcomes may help determine the use of imaging on operative planning and counseling patients with lymphedema.
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