Multipoint injection indocyanine green lymphography can reduce lymphaticovenular anastomosis surgical time and improve the surgical results for lymphedema

Ma, Gejia; Cui, Xin; Han, Ying‐Hao; Wang, Wenfei; Liu, Bin

doi:10.20517/2347-9264.2021.20

Cited by 3 publications

(4 citation statements)

References 10 publications

(10 reference statements)

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“…This will be seen as interrupted linear pattern in ICG lymphography. To allow ICG to re-enter the lymphatic channels and resume antegrade flow, it is injected anatomically proximal to such an area of linear pattern interruption [Figure 2] [9] .…”

Section: Discussionmentioning

confidence: 99%

Distal- to- proximal sequential ICG injection technique (DOPSIT) for lymphatic vessels mapping

Chen¹,

Pandey²

2023

Plast Aesthet Res

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Supermicrosurgical lymphaticovenular anastomosis (LVA) is the most sought-after procedure among lymphedema patients. However, the same enthusiasm is currently not shared among lymphedema surgeons due to the lackluster results of LVA. The common unfavorable experience with this famed procedure is at least partially caused by the difficulty in finding the lymph vessels. We share our time-tested indocyanine green-based lymph vessel mapping technique, which has helped us establish LVA as our procedure for all fluid-predominant lymphedema.

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Section: Discussionmentioning

confidence: 99%

Distal- to- proximal sequential ICG injection technique (DOPSIT) for lymphatic vessels mapping

Chen¹,

Pandey²

2023

Plast Aesthet Res

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“…After 30 min of injection, the infrared imaging system of Photodynamic Eye (PDE, Hamamatsu Photonics, Japan) generated the subcutaneous ICG imaging. In the absence of evident lymphatic development, the multi-point injection mode 13 was used; four injection points were placed at the medial and lateral sides of the knee and the medial and lateral malleoli, respectively. In vitro irradiation using the infrared probe helped determine the patency of lymphatic vessels and mark their position (Figure 1(a)).…”

Section: Operative Techniquementioning

confidence: 99%

“…The calculation formula for the score of the Lymph-ICF-LL full scale and subscale is (the sum of the scores of the questions answered/the number of answered questions) × 10; hence, the score range of the full scale and each subscale is from 0 to 100. Five levels of lower limb lymphedema were identified using overall and subscale scores of Lymph-ICF-LL: no edema (score 0-4), mild edema (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24), moderate edema (25-49), severe edema (50-95), and very severe edema (96-100). Research results have shown that Lymph-ICF-LL has good reliability and validity in both Chinese version 20 and other language versions.…”

Section: Lower Extremity Lymphedema Indexmentioning

confidence: 99%

Application of indocyanine green lymphography combined with methylene blue staining in lymphaticovenular anastomosis of lower limb vessels: A prospective study

et al. 2023

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Background Methylene blue (MB) is a conventional lymphatic tracer. We evaluated the application of indocyanine green (ICG) lymphography combined with MB staining in lower limb lymphaticovenular anastomosis (LVA). Methods A total of 49 patients with lower limb lymphedema were selected as the study subjects and divided into the research ( n = 27) and control groups ( n = 22). The patients were treated with LVA using ICG lymphography combined with MB staining and simple ICG lymphography as the positioning method, respectively. The number of lymphatic vessels anastomosed and the operating time were compared between the groups. Lower Extremity Lymphedema Index (LEL index) and Lymphoedema Functioning, Disability and Health Questionnaire for Lower Limb Lymphoedema (Lymph-ICF-LL) were used as prognostic indices; 6 months after LVA, both groups were evaluated for the symptomatic relief of lymphedema. Results The number of anastomotic lymphatic vessels in the study group was higher than that in the control group ( p < .05), and their procedural time was shorter than that in the control group. The two groups had no significant difference in lymphatic anastomosis time ( p > .05). The LEL index and Lymph-ICF-LL of the research and control groups at 6-month follow-up after LVA were lower than those before the operation ( p < .05). Conclusion The circumference of the affected limb is reduced after LVA in patients with lower extremity lymphedema with a favorable prognosis. ICG lymphography combined with MB staining has the advantages of real-time visualization and accurate localization.

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“…In this minimally invasive imaging technique, indocyanine green (ICG), a fluorescent cyanine dye, is injected intradermally, and the flow and distribution of this dye in the body are analyzed using a near-infrared optical system. Further, because ICG molecules strongly bind to plasma proteins within the blood vessels and lymphatic vessels (LVs), they move along the blood and lymph fluid with few leakages out of the vessels 4 , 5 . Regarding optical properties, ICG molecules absorb infrared light between 600 and 900 nm, which has a 789 nm peak, and emit fluorescent light between 750 and 950 nm, which has an 814 nm peak 6 .…”

Section: Introductionmentioning

confidence: 99%

Investigation of optimizing indocyanine green solution for in vivo lymphatic research using near-infrared fluorescence indocyanine green lymphangiography

Cheon,

Kim,

Kim

et al. 2023

Sci Rep

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Despite the tireless efforts of many researchers in lymphatic research, indocyanine green (ICG) solution conditions suitable for lymphatic circulation tests have not been perfectly established yet. We aimed to investigate the optimal in vivo conditions of ICG solution to avoid photobleaching and quenching effects, which may affect the accuracy of lymphatic circulation evaluation. After ICG fluorescence intensity (or ICG intensity) was assessed under different in vitro conditions, the image quality of brachial lymph nodes (LNs) and collecting lymphatic vessels (LVs) in eight rats was investigated. The in vitro results showed that ICG intensity depends on concentration and time in various solvents; however, the brightest intensity was observed at a concentration of 8–30 μg/mL in all solvents. ICG concentration in the albumin (bovine serum albumin; BSA) solution and rat’s plasma showed more than two times higher fluorescence intensity than in distilled water (DW) in the same range. However, saline reduced the intensity by almost half compared to DW. In the in vivo experiment, we obtained relatively high-quality images of the LNs and LVs using ICG in the BSA solution. Even at low concentrations, the result in the BSA solution was comparable to those obtained from high-concentration solutions commonly used in conventional circulation tests. This study provides valuable information about the conditions for optimal ICG intensity in near infrared fluorescence indocyanine green (NIRF-ICG) lymphangiography, which may be useful not only for the diagnosis of lymphatic circulation diseases such as lymphedema but also for preclinical research for the lymphatic system.

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Multipoint injection indocyanine green lymphography can reduce lymphaticovenular anastomosis surgical time and improve the surgical results for lymphedema

Abstract: injection indocyanine green lymphography can reduce lymphaticovenular anastomosis surgical time and improve the surgical results for lymphedema.

Cited by 3 publications

References 10 publications

Distal- to- proximal sequential ICG injection technique (DOPSIT) for lymphatic vessels mapping

Distal- to- proximal sequential ICG injection technique (DOPSIT) for lymphatic vessels mapping

Application of indocyanine green lymphography combined with methylene blue staining in lymphaticovenular anastomosis of lower limb vessels: A prospective study

Investigation of optimizing indocyanine green solution for in vivo lymphatic research using near-infrared fluorescence indocyanine green lymphangiography

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