Preoperative Planning of Lymphatico-venous Anastomosis

The Use of Magnetic Resonance Lymphangiography as a Complement to Indocyanine Green Lymphography:

Publication date: Available online 2 March 2019

Source: Journal of Plastic, Reconstructive & Aesthetic Surgery

Author(s): G. Pons, J.A. Clavero, X. Alomar, E. Rodríguez-Bauza, L.K. Tom, J. Masia

Abstract

Background

Lymphatico-venous anastomosis (LVA) is a surgical treatment for lymphoedema that requires identification and mapping of functional lymphatic channels. This technique was performed blindly for years due to the lack of suitable methods of study. Progress in imaging techniques and the introduction of Indocyanine green lymphography (ICG-L) represented a significant advance in lymphoedema management. Magnetic resonance lymphangiography (MRL) has also helped improve knowledge about lymphoedema anatomy and pathophysiology. We now present our protocol based on both ICG-L and MRL for optimal LVA preoperative planning.

Methods

A prospective study between April 2010 - June 2015 was conducted in 82 patients (77 females, mean age 45.5 years) with stage I (9.8%), II (73.2%) and III (17.0%) lymphedema. All patients underwent lymphoedema surgical treatment with LVA. Surgery was planned based on preoperative information from ICG- L and MRL.

Results

We obtained a mean of 6.87 lymphatic locations per extremity from MRL and selected a mean of 4.04 for LVA. When MRL data coincided with ICG-L data we found a functional lymphatic vessel in 96.9% of cases and performed LVA successfully in 91.4%.

Conclusions

ICG-L and MRL are non-invasive techniques that provide images of the lymphatic system with sufficient temporal and spatial resolution to depict functional lymphatic vessels. Such knowledge is essential for preoperative planning of LVA microsurgery. We present our protocol for the approach to surgical treatment of lymphoedema. This protocol represents a step forward in unifying patient selection criteria and achieving safe, effective and rational surgery.