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Exclusive use of ultrasound for locating optimal LVA sites—A descriptive data analysis
Author(s) -
CzedikEysenberg Ma,
Steinbacher Johannes,
Obermayer Brigitte,
Yoshimatsu Hidehiko,
Hara Hisako,
Mihara Makoto,
Tzou ChiehHan J.,
Meng Stefan
Publication year - 2020
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.25728
Subject(s) - lymphatic system , medicine , lymphedema , indocyanine green , ultrasound , anastomosis , dermis , lymphatic vessel , lymph , radiology , anatomy , pathology , surgery , cancer , breast cancer , metastasis
Background The current standard to locate lymphatic vessels for lymphovenous anastomosis (LVA) is the use of indocyanine green (ICG)‐lymphangiography. Due to fluid retention and fibrosis of tissue in patients with lymphedema, often present in Caucasian patients, vessels deeper than 0.5 cm below the dermis cannot be visualized. We present our experiences with ultrasound in locating deeper lymphatic vessels in lower extremities. Materials and Methods In total, 28 patients with lymphedema and positive lymphoscintigraphy were included. With ultrasound, we located 82 lymphatic vessels in lower extremities preoperatively without the use of ICG marking. Vessel diameter, depth, and exact location were examined. Using a coordinate system, a mapping of the detected lymphatic vessels was created. The ultrasound findings were confirmed under microscope and ICG intraoperatively. Results In all, we detected 28 Caucasian patients and 82 lymphatic vessels with ultrasound preoperatively. On average, we found three lymphatic vessels (range, 2‐6) at each patient. Of the ultrasound‐detected lymphatic vessels, 90.2% could be verified intraoperatively under a microscope. Before skin incision, lymphatic vessels could be visualized in 40% of our patients with ICG. In the mapping of the lymphatic vessels, we found no significant pattern. Conclusion Ultrasound can precisely detect lymphatic vessels for efficient LVA operation without the prior use of ICG‐lymphangiography.