Long-term Use of Ultrasound for Locating Optimal LVA Sites: A Descriptive Data Analysis

Mohos, Balázs; Czedik‐Eysenberg, Manon; Steinbacher, Johannes; Tinhofer, Ines; Meng, Stefan; Tzou, Chieh‐Han John

doi:10.1055/s-0041-1740124

Cited by 9 publications

(18 citation statements)

References 37 publications

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“…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%

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: Ultrasoundmentioning

confidence: 99%

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

et al. 2022

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“…A didactic interaction was held with the patient during the course of surgery, with an overhead screen transmitting live video feed to the patients, who were encouraged to be an active part of the whole procedure. Standardized localization of the lymphatics and corresponding veins was done with the aid of a high frequency ultrasound preoperatively 9 , 10 and the same findings were confirmed with the help of an indocyanine green (ICG) dye based lymphangiography, just before commencement of surgery. Impetus was given to the sites where ultrasound and ICG findings overlapped while keeping the pattern and topography of lymphedema in mind.…”

Section: Techniquementioning

confidence: 98%

“…ultrasound findings. 10 A combined clinical judgment was made thereof, regarding the final choice of sites, where LVAs were carried out through short incisions measuring around 2 cm. The lymphatic vessels and the vein were dissected in preparation for carrying out a tension-free anastomosis and both were brought together and placed over a surgical background (Micro-Grid Green, Medtronic, Jacksonville, Fla.) to assess the size mismatch and to get a tentative idea about the type of double barreling that would be appropriate (Fig.…”

Section: Techniquementioning

confidence: 99%

“…The lymphatic patterns had no direct bearing on our anastomosis technique, as our primary mode of localizing lymphatics remains ultrasound, and ICG lymphangiogram is done additionally just to corroborate the ultrasound findings. 10 A combined clinical judgment was made thereof, regarding the final choice of sites, where LVAs were carried out through short incisions measuring around 2 cm.…”

Section: Techniquementioning

confidence: 99%

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“Double Barrel” Lymphaticovenous Anastomosis: A Useful Addition to a Supermicrosurgeon’s Repertoire

Masoodi¹,

Steinbacher²,

Tinhofer³

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Background: Microsurgical amelioration of lymphedema has gained much traction in recent years and is now an established modality of treatment for this condition. Despite the development of many newer techniques, lymphaticovenous anastomosis still remains the most frequently carried out microsurgical procedure for lymphedema. One of the most common hurdles faced by lymphatic surgeons while carrying out a lymphaticovenous anastomosis is a mismatch in sizes of the vein and the lymphatic vessels. Method: This article describes a novel but simple “double barrel” technique, developed by the authors for carrying out lymphaticovenous anastomosis in cases of such lymphaticovenous mismatch. Seventeen double barrel anastomoses were carried out in 12 lymphedema patients, over a 4-year period from 2017 to 2021. Results: The overall success rate was 100%, as measured by clinical observation (venous washout, lymphatic backflow), the Acland vessel strip test, and by means of intraoperative ICG lymphography. Mild leakage was observed in four cases after release of the venous clamp and was corrected by application of additional sutures. Conclusions: The double barrel technique is a safe and effective tool that can be employed to deal with the bane of size mismatch, a persistent problem faced by lymphedema surgeons universally. Although we do not advocate it as a total replacement for other techniques, it can be a worthy addition to the present set of available options. In specific scenarios of mismatch with additional challenges, the double barrel technique has the potential to be considered as primus inter pares.

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“…Lymphatic vessels and superficial veins were traced on sites of commonly known pathways of lymphatic vessels. 21,25 Technical details are summarized below. Once lymphatic vessels and veins were identified, the patterns and paths of vessels were marked on the skin with a marker.…”

Section: High Frequency Color Doppler Ultrasoundmentioning

confidence: 99%

Comparative Analysis of Preoperative High Frequency Color Doppler Ultrasound versus MR Lymphangiography versus ICG Lymphography of Lymphatic Vessels in Lymphovenous Anastomosis

Kim

Jung

Cho

et al. 2022

J Reconstr Microsurg

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Introduction Despite the extensive use of various imaging modalities, there is limited literature on comparing the reliability between indocyanine green (ICG) lymphography, MR Lymphangiogram (MRL), and high frequency color Doppler ultrasound (HFCDU) to identify lymphatic vessels. Method In this study of 124 patients, the correlation between preoperative image findings to the actual lymphatic vessel leading to lymphovenous anastomosis (LVA) was evaluated. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and simple detection were calculated. Subgroup analysis was also performed according to the severity of lymphedema. Results Total of 328 LVAs were performed. The HFCDU overall had significantly higher sensitivity for identifying lymphatic vessels (99%) over MRL (83.5%) and ICG lymphography (82.3%)(p < 0.0001). Both ICG lymphography and HFCDU had 100% specificity and PPV. The NPV was 3.6%, 6.5% and 57.1% respectively for MRL, ICG lymphography, and HFCDU. All modalities showed high sensitivity for early stage 2 lymphedema while HFCDU showed a significantly higher sensitivity for late stage 2 (MRL:79.7%, ICG:83.1%, HFCDU:97%) and stage 3 (MRL:79.7%, ICG:79.7%, HFCDU:100%) over the other two modalities (p < 0.0001). Conclusion This study demonstrated while all three modalities are able to provide good information, the sensitivity may alter as the severity of lymphedema progresses. The HFCDU will provide the best detection for lymphatic vessels throughout all stages of lymphedema. However, as each modality provides different and unique information, combining and evaluating the data according to the stage of lymphedema will be able to maximize the chance for a successful surgical outcome.

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Long-term Use of Ultrasound for Locating Optimal LVA Sites: A Descriptive Data Analysis

Cited by 9 publications

References 37 publications

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

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

“Double Barrel” Lymphaticovenous Anastomosis: A Useful Addition to a Supermicrosurgeon’s Repertoire

Comparative Analysis of Preoperative High Frequency Color Doppler Ultrasound versus MR Lymphangiography versus ICG Lymphography of Lymphatic Vessels in Lymphovenous Anastomosis

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