Post-therapeutic Lymphedema: Scintigraphy Before and After Autologous Lymph Vessel Transplantation

Abstract

The function of lymphatic vessel grafts was proved in 12 patients with lymphedema of the upper extremity by visual and semiquantitative evaluation of a preoperative baseline study and scintigraphic follow-up data for a period of 8 years after microsurgical treatment. The transplantation site was an upper extremity. In 11 of 12 patients, lymphatic function improved after autologous lymphatic vessel transplantation compared with preoperative findings. This could be verified by a statistically significant decrease of the transport index ( < 0.01), clear demonstration of lymph nodes, and a less diffuse distribution pattern of the Tc-99m-labeled nanocolloids. In three patients, the vessel graft could be detected by scintigraphy. Lymphoscintigraphy combined with semiquantitative evaluation of lymphatic transport kinetics has been shown to be an easy and reliable method to assess lymphatic function before and after autologous lymph vessel transplantation.

Supermicrosurgical lymphaticovenular anastomosis and lymphaticovenous implantation for treatment of unilateral lower extremity lymphedema

“…5,8,9,13,14,17,19,[22][23][24] The findings in our patients confirmed these authors, but the condition and level of the remaining lymphatics is very difficult to estimate preoperatively with clinical or scintigraphic findings, and the timing of the occlusion and degeneration of the smooth muscle cells at the walls of lymphatics may not directly correspond to the duration of the edema 10 ; the stage of the disease seems to be more decisive. An intraoperative observation worth to mention here is, segmental contraction of the lymphangions, recognized clearly in four of our cases (three stage II and one stage III), may be a unique sign for a good outcome after lymphaticovenular anastomosis.…”

“…They, subsequently, argued that it was not possible to interpret the direct benefit from the surgical procedure above the improvement from compression therapy in other series where postoperative compression was used. 23 They also claimed that there are no currently available means to study lymphatic vessel patency. 11 The preoperative and postoperative volumes of the edema, the protocol of using postoperative garments (including the patients with no compression) are unequivocally presented in this study.…”

Lymphatic venous anastomosis (LVA) for treatment of secondary arm lymphedema. A prospective study of 11 LVA procedures in 10 patients with breast cancer related lymphedema and a critical review of the literature

“…To exemplify the results of LVA, we chose objective outcome parameters for improvement of lymphtransport capacity, volume changes and quality of life. Kleinhans et al demonstrated the usefulness of the Transport Index to evaluate the results of lymphatic grafting [25][26][27].…”

Lymphabflussszintigrafie

“…Fehlbefunde k ö nnen durch Vermeidung einer intravasalen Applikation des Radiopharmakons verhindert werden [8,15,24,26,27,30,31,46,48] . Zudem kann als Therapiekontrolle ü ber viele Jahre hinweg eine persistierende Funktion der Lymphgef ä ß transplantate durch die lymphszintigrafi sche Bildgebung im Vergleich zum pr ä operativen Zustand dokumentiert werden [5,42,43] . Bei einer ü ber die Beurteilung mittels Transportindex hinausgehende Quantifi zierung des Lymphabtransportes mittels Regions-of-Interest, muss bei klinischen Untersuchungen ber ü cksichtigt werden, dass hierbei die Ergebnisse stark von der w ä hrend des Untersuchungszeitraumes ausge ü bten Muskelanstrengung seitens des Patienten abh ä ngen; letztere m ü ssen daher streng standardisiert werden.…”