Outcomes of lymphaticovenous side-to-end anastomosis in peripheral lymphedema
Objective Lymphaticovenous anastomosis has been used for patients with peripheral lymphedema. However, the efficacy of this procedure is controversial due to a lack of evidence regarding postoperative patency. We sought to determine midterm postoperative patency of lymphaticovenous side-to-end anast...
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| Veröffentlicht in: | Journal of vascular surgery 2012-03, Vol.55 (3), p.753-760 |
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| creator | Maegawa, Jiro, MD Yabuki, Yuichiro, MD Tomoeda, Hiroto, MD Hosono, Misato, MD Yasumura, Kazunori, MD |
| description | Objective Lymphaticovenous anastomosis has been used for patients with peripheral lymphedema. However, the efficacy of this procedure is controversial due to a lack of evidence regarding postoperative patency. We sought to determine midterm postoperative patency of lymphaticovenous side-to-end anastomoses (LVSEAs) using indocyanine green fluorescence lymphography. Methods This was a retrospective observational study set in a teaching hospital. Of 107 patients with chronic lymphedema who underwent 472 LVSEAs, 57 (223 anastomoses) consented to fluorescence lymphography and comprised the study cohort. The intervention consisted of a microsurgical LVSEA performed with a suture-stent method. Patients also had preoperative and postoperative complex decongestive physiotherapy. Anastomosis patency was assessed using indocyanine green fluorescence lymphography ≥6 months after surgery. Patency rates were calculated using Kaplan-Meier analysis. We assessed volume reduction on the operated-on limb and compared this between patients in whom anastomoses were patent and those in whom anastomoses were not obviously patent. Results Patency could be evaluated only at the dorsum of the foot, ankle, and lower leg because the near-infrared rays emitted by the special camera used could not penetrate the deep subcutaneous layer containing collective lymphatics in areas such as the thigh. Several patterns were observed on fluorescence lymphography: straight, radial, and L-shaped. Cumulative patency rates of LVSEAs were 75% at 12 months and 36% at 24 months after surgery. No significant difference in volume change of the affected limb was seen between the 34 patients with patent anastomosis (600 ± 969 mL) and the 24 patients without obvious evidence of patency (420 ± 874 mL). Conclusions Although further study is required to determine factors leading to anastomotic obstruction and to optimize the results of microlymphatic surgery, the present LVSEA technique appears promising. |
| doi_str_mv | 10.1016/j.jvs.2011.08.062 |
| format | Article |
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However, the efficacy of this procedure is controversial due to a lack of evidence regarding postoperative patency. We sought to determine midterm postoperative patency of lymphaticovenous side-to-end anastomoses (LVSEAs) using indocyanine green fluorescence lymphography. Methods This was a retrospective observational study set in a teaching hospital. Of 107 patients with chronic lymphedema who underwent 472 LVSEAs, 57 (223 anastomoses) consented to fluorescence lymphography and comprised the study cohort. The intervention consisted of a microsurgical LVSEA performed with a suture-stent method. Patients also had preoperative and postoperative complex decongestive physiotherapy. Anastomosis patency was assessed using indocyanine green fluorescence lymphography ≥6 months after surgery. Patency rates were calculated using Kaplan-Meier analysis. We assessed volume reduction on the operated-on limb and compared this between patients in whom anastomoses were patent and those in whom anastomoses were not obviously patent. Results Patency could be evaluated only at the dorsum of the foot, ankle, and lower leg because the near-infrared rays emitted by the special camera used could not penetrate the deep subcutaneous layer containing collective lymphatics in areas such as the thigh. Several patterns were observed on fluorescence lymphography: straight, radial, and L-shaped. Cumulative patency rates of LVSEAs were 75% at 12 months and 36% at 24 months after surgery. No significant difference in volume change of the affected limb was seen between the 34 patients with patent anastomosis (600 ± 969 mL) and the 24 patients without obvious evidence of patency (420 ± 874 mL). Conclusions Although further study is required to determine factors leading to anastomotic obstruction and to optimize the results of microlymphatic surgery, the present LVSEA technique appears promising.</description><identifier>ISSN: 0741-5214</identifier><identifier>EISSN: 1097-6809</identifier><identifier>DOI: 10.1016/j.jvs.2011.08.062</identifier><identifier>PMID: 22209609</identifier><identifier>CODEN: JVSUES</identifier><language>eng</language><publisher>New York, NY: Mosby, Inc</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical ; Biological and medical sciences ; Cardiovascular system ; Chronic Disease ; Coloring Agents ; Female ; Hospitals, Teaching ; Humans ; Indocyanine Green ; Investigative techniques of hemodynamics ; Investigative techniques, diagnostic techniques (general aspects) ; Japan ; Kaplan-Meier Estimate ; Lymphatic Vessels - surgery ; Lymphedema - diagnosis ; Lymphedema - surgery ; Lymphography - methods ; Male ; Medical sciences ; Microsurgery - methods ; Middle Aged ; Predictive Value of Tests ; Retrospective Studies ; Subcutaneous Tissue - blood supply ; Surgery ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Time Factors ; Treatment Outcome ; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels ; Veins - surgery ; Young Adult</subject><ispartof>Journal of vascular surgery, 2012-03, Vol.55 (3), p.753-760</ispartof><rights>Society for Vascular Surgery</rights><rights>2012 Society for Vascular Surgery</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2012 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c480t-8308f0a89ff0a2bdd3f30089ced688fd0e2f9189577b9367ac3e5bddc27d2d9b3</citedby><cites>FETCH-LOGICAL-c480t-8308f0a89ff0a2bdd3f30089ced688fd0e2f9189577b9367ac3e5bddc27d2d9b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jvs.2011.08.062$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,3548,27922,27923,45993</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=25610051$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22209609$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Maegawa, Jiro, MD</creatorcontrib><creatorcontrib>Yabuki, Yuichiro, MD</creatorcontrib><creatorcontrib>Tomoeda, Hiroto, MD</creatorcontrib><creatorcontrib>Hosono, Misato, MD</creatorcontrib><creatorcontrib>Yasumura, Kazunori, MD</creatorcontrib><title>Outcomes of lymphaticovenous side-to-end anastomosis in peripheral lymphedema</title><title>Journal of vascular surgery</title><addtitle>J Vasc Surg</addtitle><description>Objective Lymphaticovenous anastomosis has been used for patients with peripheral lymphedema. However, the efficacy of this procedure is controversial due to a lack of evidence regarding postoperative patency. We sought to determine midterm postoperative patency of lymphaticovenous side-to-end anastomoses (LVSEAs) using indocyanine green fluorescence lymphography. Methods This was a retrospective observational study set in a teaching hospital. Of 107 patients with chronic lymphedema who underwent 472 LVSEAs, 57 (223 anastomoses) consented to fluorescence lymphography and comprised the study cohort. The intervention consisted of a microsurgical LVSEA performed with a suture-stent method. Patients also had preoperative and postoperative complex decongestive physiotherapy. Anastomosis patency was assessed using indocyanine green fluorescence lymphography ≥6 months after surgery. Patency rates were calculated using Kaplan-Meier analysis. We assessed volume reduction on the operated-on limb and compared this between patients in whom anastomoses were patent and those in whom anastomoses were not obviously patent. Results Patency could be evaluated only at the dorsum of the foot, ankle, and lower leg because the near-infrared rays emitted by the special camera used could not penetrate the deep subcutaneous layer containing collective lymphatics in areas such as the thigh. Several patterns were observed on fluorescence lymphography: straight, radial, and L-shaped. Cumulative patency rates of LVSEAs were 75% at 12 months and 36% at 24 months after surgery. No significant difference in volume change of the affected limb was seen between the 34 patients with patent anastomosis (600 ± 969 mL) and the 24 patients without obvious evidence of patency (420 ± 874 mL). Conclusions Although further study is required to determine factors leading to anastomotic obstruction and to optimize the results of microlymphatic surgery, the present LVSEA technique appears promising.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anastomosis, Surgical</subject><subject>Biological and medical sciences</subject><subject>Cardiovascular system</subject><subject>Chronic Disease</subject><subject>Coloring Agents</subject><subject>Female</subject><subject>Hospitals, Teaching</subject><subject>Humans</subject><subject>Indocyanine Green</subject><subject>Investigative techniques of hemodynamics</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Japan</subject><subject>Kaplan-Meier Estimate</subject><subject>Lymphatic Vessels - surgery</subject><subject>Lymphedema - diagnosis</subject><subject>Lymphedema - surgery</subject><subject>Lymphography - methods</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Microsurgery - methods</subject><subject>Middle Aged</subject><subject>Predictive Value of Tests</subject><subject>Retrospective Studies</subject><subject>Subcutaneous Tissue - blood supply</subject><subject>Surgery</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels</subject><subject>Veins - surgery</subject><subject>Young Adult</subject><issn>0741-5214</issn><issn>1097-6809</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU2LFDEQhoMo7rj6A7xIX8RTt5X0V4IgyOIXrOxBPYdMUmHTdnfaVPfA_HszzKjgwUvl8rxVlacYe86h4sC710M1HKgSwHkFsoJOPGA7DqovOwnqIdtB3_CyFby5Yk-IBshgK_vH7EoIAaoDtWNf7rbVxgmpiL4Yj9Nyb9Zg4wHnuFFBwWG5xhJnV5jZ0BqnSIGKMBcLprDcYzLjOYYOJ_OUPfJmJHx2ea_Z9w_vv918Km_vPn6-eXdb2kbCWsoapAcjlc9V7J2rfQ0glUXXSekdoPCKS9X2_V7VXW9sjW3GrOidcGpfX7NX575Lij83pFVPgSyOo5kx762VaFRXN1Jmkp9JmyJRQq-XFCaTjpqDPknUg84S9UmiBqmzxJx5cem-7Sd0fxK_rWXg5QUwZM3ok5ltoL9c23GAlmfuzZnD7OIQMGmyAef8zZDQrtrF8N813v6TtmOYQx74A49IQ9zSnCVrrklo0F9P1z4dm3MQTSd4_QuPR6VC</recordid><startdate>20120301</startdate><enddate>20120301</enddate><creator>Maegawa, Jiro, MD</creator><creator>Yabuki, Yuichiro, MD</creator><creator>Tomoeda, Hiroto, MD</creator><creator>Hosono, Misato, MD</creator><creator>Yasumura, Kazunori, MD</creator><general>Mosby, Inc</general><general>Elsevier</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20120301</creationdate><title>Outcomes of lymphaticovenous side-to-end anastomosis in peripheral lymphedema</title><author>Maegawa, Jiro, MD ; Yabuki, Yuichiro, MD ; Tomoeda, Hiroto, MD ; Hosono, Misato, MD ; Yasumura, Kazunori, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c480t-8308f0a89ff0a2bdd3f30089ced688fd0e2f9189577b9367ac3e5bddc27d2d9b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anastomosis, Surgical</topic><topic>Biological and medical sciences</topic><topic>Cardiovascular system</topic><topic>Chronic Disease</topic><topic>Coloring Agents</topic><topic>Female</topic><topic>Hospitals, Teaching</topic><topic>Humans</topic><topic>Indocyanine Green</topic><topic>Investigative techniques of hemodynamics</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>Japan</topic><topic>Kaplan-Meier Estimate</topic><topic>Lymphatic Vessels - surgery</topic><topic>Lymphedema - diagnosis</topic><topic>Lymphedema - surgery</topic><topic>Lymphography - methods</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Microsurgery - methods</topic><topic>Middle Aged</topic><topic>Predictive Value of Tests</topic><topic>Retrospective Studies</topic><topic>Subcutaneous Tissue - blood supply</topic><topic>Surgery</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels</topic><topic>Veins - surgery</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Maegawa, Jiro, MD</creatorcontrib><creatorcontrib>Yabuki, Yuichiro, MD</creatorcontrib><creatorcontrib>Tomoeda, Hiroto, MD</creatorcontrib><creatorcontrib>Hosono, Misato, MD</creatorcontrib><creatorcontrib>Yasumura, Kazunori, MD</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of vascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Maegawa, Jiro, MD</au><au>Yabuki, Yuichiro, MD</au><au>Tomoeda, Hiroto, MD</au><au>Hosono, Misato, MD</au><au>Yasumura, Kazunori, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcomes of lymphaticovenous side-to-end anastomosis in peripheral lymphedema</atitle><jtitle>Journal of vascular surgery</jtitle><addtitle>J Vasc Surg</addtitle><date>2012-03-01</date><risdate>2012</risdate><volume>55</volume><issue>3</issue><spage>753</spage><epage>760</epage><pages>753-760</pages><issn>0741-5214</issn><eissn>1097-6809</eissn><coden>JVSUES</coden><abstract>Objective Lymphaticovenous anastomosis has been used for patients with peripheral lymphedema. However, the efficacy of this procedure is controversial due to a lack of evidence regarding postoperative patency. We sought to determine midterm postoperative patency of lymphaticovenous side-to-end anastomoses (LVSEAs) using indocyanine green fluorescence lymphography. Methods This was a retrospective observational study set in a teaching hospital. Of 107 patients with chronic lymphedema who underwent 472 LVSEAs, 57 (223 anastomoses) consented to fluorescence lymphography and comprised the study cohort. The intervention consisted of a microsurgical LVSEA performed with a suture-stent method. Patients also had preoperative and postoperative complex decongestive physiotherapy. Anastomosis patency was assessed using indocyanine green fluorescence lymphography ≥6 months after surgery. Patency rates were calculated using Kaplan-Meier analysis. We assessed volume reduction on the operated-on limb and compared this between patients in whom anastomoses were patent and those in whom anastomoses were not obviously patent. Results Patency could be evaluated only at the dorsum of the foot, ankle, and lower leg because the near-infrared rays emitted by the special camera used could not penetrate the deep subcutaneous layer containing collective lymphatics in areas such as the thigh. Several patterns were observed on fluorescence lymphography: straight, radial, and L-shaped. Cumulative patency rates of LVSEAs were 75% at 12 months and 36% at 24 months after surgery. No significant difference in volume change of the affected limb was seen between the 34 patients with patent anastomosis (600 ± 969 mL) and the 24 patients without obvious evidence of patency (420 ± 874 mL). Conclusions Although further study is required to determine factors leading to anastomotic obstruction and to optimize the results of microlymphatic surgery, the present LVSEA technique appears promising.</abstract><cop>New York, NY</cop><pub>Mosby, Inc</pub><pmid>22209609</pmid><doi>10.1016/j.jvs.2011.08.062</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Adult Aged Aged, 80 and over Anastomosis, Surgical Biological and medical sciences Cardiovascular system Chronic Disease Coloring Agents Female Hospitals, Teaching Humans Indocyanine Green Investigative techniques of hemodynamics Investigative techniques, diagnostic techniques (general aspects) Japan Kaplan-Meier Estimate Lymphatic Vessels - surgery Lymphedema - diagnosis Lymphedema - surgery Lymphography - methods Male Medical sciences Microsurgery - methods Middle Aged Predictive Value of Tests Retrospective Studies Subcutaneous Tissue - blood supply Surgery Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Time Factors Treatment Outcome Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels Veins - surgery Young Adult |
| title | Outcomes of lymphaticovenous side-to-end anastomosis in peripheral lymphedema |
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