Preoperative planning of lymphaticovenous anastomosis: The use of magnetic resonance lymphangiography as a complement to indocyanine green lymphography

Pons, Gemma; Clavero, Juan A.; Alomar, Xavier; Rodríguez-Bauzà, Elena; Tom, Laura K.; Masià, Jaume

doi:10.1016/j.bjps.2019.02.024

Cited by 46 publications

(51 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Stained subdermal lymphatic vessels appeared within 1 min and continued proximally, assisting the surgery (Ayestaray, Bekara, & Andreoletti, 2013; Yap et al, 2009). Incisions were performed under magnification and preferentially placed over linear lymphatic pattern, which suggested healthy, functioning lymphatic vessels, just distal to an area of dermal backflow (Pons et al, 2019; Yamamoto, Yamamoto, Fuse, Narushima, & Koshima, 2018). According to previous reports, we located our incisions and performed LVAs on the most proximal aspect of a linear pattern before an area of dermal backflow (Kaciulyte et al, 2019; Yamamoto et al, 2018).…”

Section: Methodsmentioning

confidence: 99%

A prospective study on combined lymphedema surgery: Gastroepiploic vascularized lymph nodes transfer and lymphaticovenous anastomosis followed by suction lipectomy

et al. 2020

View full text Add to dashboard Cite

Background There is no consensus on the appropriate treatment of lymphedema. Proposed techniques include lymphaticovenous anastomosis (LVA), vascularized lymph nodes transfer (VLNT), and suction lipectomy (SL). The benefit of combined procedures has also been postulated. In this prospective study, a combined protocol is proposed as an alternative to single‐procedure strategies. Methods Between January 2016 and October 2018, we enrolled patients with secondary lymphedema of lower limbs, stage II‐III according to the International Society of Lymphology, progressive swelling and skin tonicity >60. Thirty‐seven consecutive patients were dichotomized into group I, undergoing VLNT, and group II undergoing VLNT and LVA. Gastroepiploic lymphnode flap was harvested through laparoscopy, and in the same operation, LVAs were performed in group II on the basis of indocyanine green lymphography and patent blue findings. Two weeks later, SL was performed in all the patients. Patients were prospectively evaluated through clinical examination, circumference measurement, and skin tonicity. Results The average follow‐up was 2 ± 0.8 years. The first consecutive 21 patients were treated with VLNT followed by SL. The next 16 patients underwent combined VLNT and LVA, followed by SL. A mean of 2.4 LVAs were performed. A significant difference in the postoperative circumference measurements was found overall (p < .05): 52.6 ± 18.9 above the knee, 42.9 ± 25 below the knee, 36.2 ± 37 at foot. The postoperative tonicity dropped by 12.7 ± 6.3% (p < .05). The episodes of cellulitis significantly decreased to 0.1 ± 0.3 (p < .05). Conclusions LVA, VLNT, and SL can be integrated together in a combined approach, in synergy to enhance the outcomes.

show abstract

Section: Methodsmentioning

confidence: 99%

A prospective study on combined lymphedema surgery: Gastroepiploic vascularized lymph nodes transfer and lymphaticovenous anastomosis followed by suction lipectomy

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Surgical flaps can now be planned with high precision to optimize aesthetic and functional outcomes (Ramly et al, 2019). Similarly, high‐quality imaging is important for lymphatic microsurgery because outcomes depend on the accurate identification of functional lymphatic vessels for anastomosis (Pons et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

“…Lymphedema treatment has advanced considerably due to the development of physiologic surgeries such as LVA and VLNT that seek to restore lymphatic function (Forte et al, 2019). One of the most challenging and burdensome parts of these procedures is locating functional lymphatic vessels and lymph nodes (Pons et al, 2019). To improve procedural efficiency and outcomes, surgeons may use indocyanine green lymphography (ICG‐L) to preoperatively identify functional lymphatic vessels and decide the locations for the LVA incisions (Unno et al, 2007).…”

Section: Introductionmentioning

confidence: 99%

“…To improve procedural efficiency and outcomes, surgeons may use indocyanine green lymphography (ICG‐L) to preoperatively identify functional lymphatic vessels and decide the locations for the LVA incisions (Unno et al, 2007). However, this technique has limitations, such as its inability to visualize deep lymphatic circulation (Pons et al, 2019). Magnetic resonance imaging lymphangiography (MRL) is done with an intracutaneous injection of a gadolinium‐based contrast agent and it is reportedly a safe, noninvasive, and high‐resolution examination for lymphatic vessel delineation in lymphedema patients (Lohrmann et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Use of magnetic resonance imaging lymphangiography for preoperative planning in lymphedema surgery: A systematic review

et al. 2021

View full text Add to dashboard Cite

Background In recent years, magnetic resonance imaging lymphangiography (MRL) has emerged as a way to predict if patients are candidates for lymphedema surgery, particularly lymphovenous anastomosis (LVA). Our goal was to conduct a systematic review of the literature on the use of MRL for preoperative planning in lymphedema surgery. We hypothesized that MRL could add valuable information to the standard preoperative evaluation of lymphedema patients. Methods On February 17, 2020, we conducted a systematic review of the PubMed/MEDLINE, Cochrane Clinical Answers, and Embase databases, without time frame or language limitations, to identify articles on the use of MRL for preoperative planning of lymphedema surgery. We excluded studies that investigated other applications of magnetic resonance imaging, such as lymphedema diagnosis and treatment evaluation. The primary outcome was the examination capacity to identify lymphatic anatomy and the secondary outcome was the presence of adverse effects. Results Of 372 potential articles identified with the search, nine studies fulfilled the eligibility criteria. A total of 334 lymphedema patients were enrolled in these studies. Two studies compared MRL findings with those of other standard examinations (indocyanine green lymphography [ICG‐L] or lymphoscintigraphy). No adverse effects due to MRL were reported. A study shown that MRL had higher sensitivity to detect lymphatic vessel abnormalities compared with lymphoscintigraphy and a statistically higher chance of successful LVA was observed when the results of MRL agreed with those of ICG‐L (p < .001). Conclusions MRL could be useful for preoperative planning in lymphedema surgery. The scientific evidence has been limited, so further studies with greater numbers of patients and cost analysis are necessary to justify the addition of MRL to current preoperative protocols.

show abstract

“…It is perhaps more pertinent to comment on the complementary nature between MRL, LS and ICG lymphography, and a combination of MRL with either may deliver a more complete understanding of lymphatic anatomy and physiology than MRL alone. While ICG yields high spatial and temporal imaging of superficial lymph vessels, which may lead to estimations of vessel contraction frequency, MRL facilitates evaluation of the lymphatic system over large anatomical regions and can image both superficial and deep lymphatic structures such as the TD 26,52 . LS, while lacking spatial and temporal resolution, is readily quantifiable to estimate tracer clearance and hence lymphatic transport.…”

Section: Discussionmentioning

confidence: 99%

Systematic Review of Magnetic Resonance Lymphangiography From a Technical Perspective

Mills

Zanten

Borri

et al. 2021

Magnetic Resonance Imaging

View full text Add to dashboard Cite

Background Clinical examination and lymphoscintigraphy are the current standard for investigating lymphatic function. Magnetic resonance imaging (MRI) facilitates three‐dimensional (3D), nonionizing imaging of the lymphatic vasculature, including functional assessments of lymphatic flow, and may improve diagnosis and treatment planning in disease states such as lymphedema. Purpose To summarize the role of MRI as a noninvasive technique to assess lymphatic drainage and highlight areas in need of further study. Study Type Systematic review. Population In October 2019, a systematic literature search (PubMed) was performed to identify articles on magnetic resonance lymphangiography (MRL). Field Strength/Sequence No field strength or sequence restrictions. Assessment Article quality assessment was conducted using a bespoke protocol, designed with heavy reliance on the National Institutes of Health quality assessment tool for case series studies and Downs and Blacks quality checklist for health care intervention studies. Statistical Tests The results of the original research articles are summarized. Results From 612 identified articles, 43 articles were included and their protocols and results summarized. Field strength was 1.5 or 3.0 T in all studies, with 25/43 (58%) employing 3.0 T imaging. Most commonly, imaging of the peripheries, upper and lower limbs including the pelvis (32/43, 74%), and the trunk (10/43, 23%) is performed, including two studies covering both regions. Imaging protocols were heterogenous; however, T2‐weighted and contrast‐enhanced T1‐weighted images are routinely acquired and demonstrate the lymphatic vasculature. Edema, vessel, quantity and morphology, and contrast uptake characteristics are commonly reported indicators of lymphatic dysfunction. Data Conclusion MRL is uniquely placed to yield large field of view, qualitative and quantitative, 3D imaging of the lymphatic vasculature. Despite study heterogeneity, consensus is emerging regarding MRL protocol design. MRL has the potential to dramatically improve understanding of the lymphatics and detect disease, but further optimization, and research into the influence of study protocol differences, is required before this is fully realized. Level of Evidence 2 Technical Efficacy Stage 2

show abstract

Preoperative planning of lymphaticovenous anastomosis: The use of magnetic resonance lymphangiography as a complement to indocyanine green lymphography

Cited by 46 publications

References 17 publications

A prospective study on combined lymphedema surgery: Gastroepiploic vascularized lymph nodes transfer and lymphaticovenous anastomosis followed by suction lipectomy

A prospective study on combined lymphedema surgery: Gastroepiploic vascularized lymph nodes transfer and lymphaticovenous anastomosis followed by suction lipectomy

Use of magnetic resonance imaging lymphangiography for preoperative planning in lymphedema surgery: A systematic review

Systematic Review of Magnetic Resonance Lymphangiography From a Technical Perspective

Contact Info

Product

Resources

About