Change of the Lymphatic Diameter in Different Body Positions

Hara, Hisako; Mihara, Makoto

doi:10.1089/lrb.2020.0081

Cited by 10 publications

(10 citation statements)

References 28 publications

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“… 141 Changing body position from supine to sitting or standing also caused a decrease in diameter. 136 Vessel diameters found with CHFUS were significantly larger than with UHFUS. 141 Moreover, larger and more vessels were detected with ultrasound compared with NIRF-L. 140 Post-surgery circumference reduction was significantly higher in this group.…”

Section: Resultsmentioning

confidence: 86%

“…High frequency ultrasound devices facilitate detailed real-time visualization of lymphatic vessels and veins. Conventional high frequencies (CHFUS) of between 15 and 24 MHz [133][134][135][136][137][138][139][140] and/or ultra-high frequencies (UHFUS) of between 48 and 70 MHz were used. 141,142 Electronic supplementary Table 9 gives an overview of the study characteristics.…”

Section: Ultrasoundmentioning

confidence: 99%

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Imaging of the Lymphatic Vessels for Surgical Planning: A Systematic Review

et al. 2022

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Background Secondary lymphedema is a common complication after surgical or radiotherapeutic cancer treatment. (Micro) surgical intervention such as lymphovenous bypass and vascularized lymph node transfer is a possible solution in patients who are refractory to conventional treatment. Adequate imaging is needed to identify functional lymphatic vessels and nearby veins for surgical planning. Methods A systematic literature search of the Embase, MEDLINE ALL via Ovid, Web of Science Core Collection and Cochrane CENTRAL Register of Trials databases was conducted in February 2022. Studies reporting on lymphatic vessel detection in healthy subjects or secondary lymphedema of the limbs or head and neck were analyzed. Results Overall, 129 lymphatic vessel imaging studies were included, and six imaging modalities were identified. The aim of the studies was diagnosis, severity staging, and/or surgical planning. Conclusion Due to its utility in surgical planning, near-infrared fluorescence lymphangiography (NIRF-L) has gained prominence in recent years relative to lymphoscintigraphy, the current gold standard for diagnosis and severity staging. Magnetic resonance lymphography (MRL) gives three-dimensional detailed information on the location of both lymphatic vessels and veins and the extent of fat hypertrophy; however, MRL is less practical for routine presurgical implementation due to its limited availability and high cost. High frequency ultrasound imaging can provide high resolution imaging of lymphatic vessels but is highly operator-dependent and accurate identification of lymphatic vessels is difficult. Finally, photoacoustic imaging (PAI) is a novel technique for visualization of functional lymphatic vessels and veins. More evidence is needed to evaluate the utility of PAI in surgical planning.

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Section: Resultsmentioning

confidence: 86%

Section: Ultrasoundmentioning

confidence: 99%

Imaging of the Lymphatic Vessels for Surgical Planning: A Systematic Review

et al. 2022

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Section: Discussionmentioning

confidence: 99%

“…However, ultrasound machines are used in almost every hospital. We have previously reported the possibility of examining lymphatic function and diagnosing lymphedema using ultrasound alone (Hara & Mihara, 2021d; Hara & Mihara, 2021e; Hara & Mihara, 2021f; Hara & Mihara, 2021g). We now report that LVA can be performed by performing ultrasonography preoperatively, due to which most cases of lymphedema can be managed by ultrasound.…”

Section: Discussionmentioning

confidence: 99%

“…We searched for dilated lymphatic vessels in the saphenous, lateral calf, and lateral thigh lymphosomes (Hara & Mihara, 2020b; Hara & Mihara, 2021c). We searched for the lymphatic vessels using lymphatic ultrasound based on the D‐CUPS (Doppler, Crossing, Uncollapsible, Parallel, and Superficial fascia) method, as previously reported (Hara & Mihara, 2021d; Hara & Mihara, 2021e; Hara & Mihara, 2021f; Hara & Mihara, 2021g; Hara & Mihara, 2021h; Hara & Mihara, 2021i). Dilated lymphatic vessels were identified in each lymphosome, and the point with appropriate veins nearby was designed as a skin incision (Figure 1).…”

Section: Methodsmentioning

confidence: 99%

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Ultrasound‐guided lymphaticovenous anastomosis without indocyanine green lymphography mapping: A preliminary report

Hara

Mihara

2022

Microsurgery

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Background Although indocyanine green (ICG) lymphography is the standard preoperative examination for lymphaticovenous anastomosis (LVA), it cannot be performed in patients allergic to ICG. This report aimed to clarify the effects of LVA with lymphatic ultrasound and without ICG lymphography. Method Lymphatic ultrasound was performed preoperatively on six limbs of four patients with lower limb lymphedema who were allergic to ICG to detect the lymphatic vessels. All patients were women and had secondary lymphedema after uterine cancer treatment, with a mean age of 57.0 years (range; 47–68 years). The severity of lymphedema was stage 2a in two limbs, stage 2b in three limbs, and stage 3 in one limb. During the preoperative lymphatic ultrasound, we searched for the dilated lymphatic vessels in the saphenous, lateral calf, and lateral thigh lymphosomes. The incision sites were determined based on the ultrasonographic findings, and LVA was performed under local anesthesia. The surgical results were evaluated based on the limb volume calculated from the circumferences. Result Totally, 13 skin incisions were made, and the lymphatic vessels consistent with the ultrasonographic findings were found in all locations. The mean number of the lymphatic vessels anastomosed per limb was 2.2 (range; 1–4). The mean diameter of the lymphatic vessel was 0.69 mm (range; 0.3–1.0 mm). No complications were observed in the perioperative period. The mean follow‐up period was 386.8 days. The mean preoperative and postoperative limb volumes were 5468 ml (range; 4552–6378 ml) and 5027.4 ml (range; 4353–5561 ml). Limb volume decreased in all six limbs. Conclusion The effectiveness of performing LVA by identifying the lymphatic vessels using lymphatic ultrasound was demonstrated. More medical institutions will be able to perform LVA in the future, even without ICG devices.

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Lymphatic refill in ultrasound and lymphatic washout after lymphaticovenous anastomosis

Hara

Mihara

2022

Microsurgery

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Background: Lymphaticovenous anastomosis (LVA) drains lymph accumulated in the lymphatic vessels into the veins (lymphatic washout). A method to identify the ideal lymphatic vessels to achieve washout has not been established. This study examined the relationship between lymphatic washout, lymphatic ultrasonographic findings, and surgical outcomes. Methods:We reviewed consecutive patients who underwent LVA for lower limb lymphedema between September 2020 and March 2021. Patients who lacked data were excluded. Preoperative ultrasonography was performed to measure the lymphatic diameter. After the probe was pressed against the skin and released, the reaction of the lymphatic vessels was classified as either refilled, crushed, undecidable, or solid. Intraoperatively, whether lymphatic washout was observed or not, was recorded and compared to preoperative findings using the chi-square test. In 54 limbs from 32 patients, the total number of LVA, number of anastomoses with washout, number of refills detected by ultrasound, and severity of lymphedema were compared with the surgical result (postoperative limb volume change) by multiple regression analysis (49 limbs whose pre-or postoperative circumference data were lacking or who underwent intensive compression therapy postoperatively were excluded).Results: Sixty-five patients were reviewed. After excluding six patients with missing data, 59 patients (103 limbs) were included. The median patient age was 63 years (interquartile range, 51-76 years). We performed LVA at 217 sites (mean, 2.1 anastomoses per limb). "Refilled" lymphatics were observed at 156 sites (71.6%) and significantly thicker than those classified as "undecidable" (p = .020 in the lower leg and p < .001 in the thigh). In the thigh, "refilled" lymphatics had a higher rate of a washout than those classified as "undecidable." In Pearson's correlation coefficient for the surgical result, as the number of washout positive LVA increased, the limb volume tended to decrease postoperatively (correlation coefficient: À0.25). However, multiple regression analysis did not identify any factors that significantly affected the surgical outcomes.Conclusion: "Refilled" lymphatic vessels had a higher rate of intraoperative lymphatic washout after anastomosis.

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Change of the Lymphatic Diameter in Different Body Positions

Cited by 10 publications

References 28 publications

Imaging of the Lymphatic Vessels for Surgical Planning: A Systematic Review

Imaging of the Lymphatic Vessels for Surgical Planning: A Systematic Review

Ultrasound‐guided lymphaticovenous anastomosis without indocyanine green lymphography mapping: A preliminary report

Lymphatic refill in ultrasound and lymphatic washout after lymphaticovenous anastomosis

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