Preoperative photoacoustic versus indocyanine green lymphography in lymphaticovenular anastomosis outcomes for lower extremity lymphedema: A pilot study

IF 1.5 3区医学 Q3 SURGERY Microsurgery Pub Date : 2024-02-20 DOI:10.1002/micr.31153

Yushi Suzuki M.D., Ph.D, Hiroki Kajita M.D., Ph.D, Shiho Watanabe M.D. Ph.D, Marika Otaki M.D, Keisuke Okabe M.D., Ph.D, Hisashi Sakuma M.D, Nobuaki Imanishi M.D., Ph.D, Kazuo Kishi M.D., Ph.D

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Abstract

Background

Identification of the proper lymphatics is important for successful lymphaticovenular anastomosis (LVA) for lymphedema; however, visualization of lymphatic vessels is challenging. Photoacoustic lymphangiography (PAL) can help visualize lymphatics more clearly than other modalities. Therefore, we investigated the usefulness of PAL and determined whether the clear and three-dimensional image of PAL affects LVA outcomes.

Methods

We recruited 22 female patients with lower extremity lymphedema. The operative time, number of incisions, number of anastomoses, lymphatic vessel detection rate (number of functional lymphatics identified during the operation/number of incisions), and limb volume changes preoperatively and 3 months postoperatively were compared retrospectively. The patients were divided according to whether PAL was performed or not, and results were compared between those undergoing PAL (PAL group; n = 10) and those who did not (near-infrared fluorescence [NIRF] group, n = 12).

Results

The mean age of the patients was 55.9 ± 15.1 years in the PAL group and 50.7 ± 14.9 years in the NIRF group. One patient in the PAL group and three in the NIRF group had primary lymphedema. Eighteen patients (PAL group, nine; and NIRF group, nine) had secondary lymphedema. Based on preoperative evaluation using the International Society of Lymphology (ISL) classification, eight patients were determined to be in stage 2 and two patients in late stage 2 in the PAL group. In contrast, in the NIRF group, one patient was determined to be in stage 0, three patients each in stage 1 and stage 2, and five patients in late stage 2.

Lymphatic vessel detection rates were 93% (42 LVAs and 45 incisions) and 83% (50 LVAs and 60 incisions) in the groups with and without PAL, respectively (p = 0.42). Limb volume change was evaluated in five limbs of four patients and in seven limbs of five patients in the PAL and NIRF groups as 336.6 ± 203.6 mL (5.90% ± 3.27%) and 52.9 ± 260.7 mL (0.71% ± 4.27%), respectively. The PAL group showed a significant volume reduction. (p = .038).

Conclusions

Detection of functional lymphatic vessels on PAL is useful for treating LVA.

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下肢淋巴水肿淋巴管吻合术的术前光声与吲哚菁绿淋巴造影对比：试点研究。

背景：识别适当的淋巴管对于成功进行淋巴管-淋巴孔吻合术（LVA）治疗淋巴水肿非常重要；然而，淋巴管的可视化具有挑战性。与其他方法相比，光声淋巴管成像（PAL）有助于更清晰地观察淋巴管。因此，我们研究了 PAL 的实用性，并确定 PAL 清晰的三维图像是否会影响淋巴管造影的结果：方法：我们招募了 22 名女性下肢淋巴水肿患者。回顾性比较了手术时间、切口数量、吻合数量、淋巴管检出率（手术中发现的功能性淋巴管数量/切口数量）以及术前和术后 3 个月的肢体体积变化。根据是否进行 PAL 对患者进行分类，并对进行 PAL 的患者（PAL 组，n = 10）和未进行 PAL 的患者（近红外荧光组，n = 12）的结果进行比较：PAL组患者的平均年龄为（55.9 ± 15.1）岁，NIRF组患者的平均年龄为（50.7 ± 14.9）岁。PAL 组和 NIRF 组分别有 1 名和 3 名患者患有原发性淋巴水肿。18名患者（PAL组9人，NIRF组9人）患有继发性淋巴水肿。根据国际淋巴学会（ISL）的分类进行术前评估，PAL 组中有 8 名患者被确定为 2 期，2 名患者为 2 期晚期。而在 NIRF 组中，1 名患者被确定为 0 期，3 名患者分别为 1 期和 2 期，5 名患者为 2 期晚期。有 PAL 组和没有 PAL 组的淋巴管检测率分别为 93%（42 个 LVA 和 45 个切口）和 83%（50 个 LVA 和 60 个切口）（P = 0.42）。经评估，PAL 组和 NIRF 组分别有 4 名患者的 5 条肢体和 5 名患者的 7 条肢体发生了体积变化，分别为 336.6 ± 203.6 mL（5.90% ± 3.27%）和 52.9 ± 260.7 mL（0.71% ± 4.27%）。PAL 组的血容量明显减少。(P=0.038）：结论：通过 PAL 检测功能性淋巴管有助于治疗 LVA。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Microsurgery 医学-外科

CiteScore

3.80

自引率

19.00%

发文量

128

审稿时长

4-8 weeks

期刊介绍： Microsurgery is an international and interdisciplinary publication of original contributions concerning surgery under microscopic magnification. Microsurgery publishes clinical studies, research papers, invited articles, relevant reviews, and other scholarly works from all related fields including orthopaedic surgery, otolaryngology, pediatric surgery, plastic surgery, urology, and vascular surgery.