Injection sites for indocyanine green lymphography to enhance minor forearm lymphatic pathways

Manual Lymphatic Drainage (MLD) appears to stimulate lymphatic contraction, aid in the development of secondary derivation pathways, and stimulate the appearance of collateral pathways that could function as the main drainage routes of the limb in case of lymphedema. Through stretching, call up maneuvers are used to stimulate lymphangion reflex contraction and, therefore, lymphatic function. The aim was to describe the presence of areas and pathways of collateral lymphatic drainage under basal conditions and to determine, using Indocyanine Green (ICG) lymphography, whether an increase in these pathways occurs after 30 min of manual lymphatic stimulation with only call up maneuvers according to the Leduc Method®®. In this prospective analytical study (pretest–posttest), the frequency of presentation of areas and collateral lymphatic pathways was analyzed in 19 patients with secondary lymphedema of the upper limb after breast cancer using an infrared camera. Analyses were completed at three time points: after ICG injection, at baseline (pretest), and after the application of MLD (post-test). The Leduc Method maneuvers were applied to the supraclavicular and axillary nodes, chest, back, Mascagni, and Caplan pathways. The areas visualized in the pretest continued to be visible in the posttest. Additional pathways and fluorescent areas were observed after the maneuvers. The McNemar test showed statistical significance (p = 0.008), the odds ratio was infinite, and the Cohen’s g value was equal to 0.5. Manual stimulation by call up maneuvers increased the observation frequency of areas and collateral lymphatic pathways. Therefore, ICG lymphography appears to be a useful tool for bringing out the routes of collateral bypass in secondary lymphoedema after cancer treatment.

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Classification of the lymphatic pathways in each lymphosome based on multi-lymphosome indocyanine green lymphography: Saphenous, Calf, and Thigh (SCaT) classification

Journal of Plastic Reconstructive & Aesthetic Surgery ◽

10.1016/j.bjps.2021.03.078 ◽

2021 ◽

Author(s):

Hisako Hara ◽

Makoto Mihara

Keyword(s):

Indocyanine Green ◽

Lymphatic Pathways

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Evaluation of Breast Lymphatic Pathways with Indocyanine Green Fluorescence Imaging in Patients with Breast Cancer

World Journal of Surgery ◽

10.1007/s00268-008-9519-7 ◽

2008 ◽

Vol 32 (9) ◽

pp. 1924-1929 ◽

Cited By ~ 66

Author(s):

Yutaka Ogasawara ◽

Hirokuni Ikeda ◽

Mina Takahashi ◽

Kensuke Kawasaki ◽

Hiroyoshi Doihara

Keyword(s):

Breast Cancer ◽

Indocyanine Green ◽

Fluorescence Imaging ◽

Green Fluorescence ◽

Indocyanine Green Fluorescence ◽

Indocyanine Green Fluorescence Imaging ◽

Lymphatic Pathways

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Enhanced type I photoreaction of indocyanine green via electrostatic-force-driven aggregation

Nanoscale ◽

10.1039/d0nr01208d ◽

2020 ◽

Vol 12 (17) ◽

pp. 9517-9523 ◽

Cited By ~ 3

Author(s):

Huizhen Fan ◽

Yu Fan ◽

Wenna Du ◽

Rui Cai ◽

Xinshuang Gao ◽

...

Keyword(s):

Mesoporous Silica ◽

Indocyanine Green ◽

Electrostatic Force ◽

Type I ◽

Positively Charged

ICG forms aggregates in positively charged mesoporous silica, which show an enhanced type I photoreaction pathway.

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Initial experience with a new quantitative assessment tool for fluorescent imaging in peripheral artery disease

VASA ◽

10.1024/0301-1526/a000642 ◽

2017 ◽

Vol 46 (5) ◽

pp. 383-388 ◽

Cited By ~ 6

Author(s):

Henrik Christian Rieß ◽

Anna Duprée ◽

Christian-Alexander Behrendt ◽

Tilo Kölbel ◽

Eike Sebastian Debus ◽

...

Keyword(s):

Indocyanine Green ◽

Quantitative Assessment ◽

Tissue Perfusion ◽

Fluorescent Imaging ◽

Peripheral Artery ◽

Peripheral Bypass ◽

Before And After ◽

Artery Disease ◽

Green Fluorescent ◽

Peripheral Bypass Grafting

Abstract. Background: Perioperative evaluation in peripheral artery disease (PAD) by common vascular diagnostic tools is limited by open wounds, medial calcinosis or an altered collateral supply of the foot. Indocyanine green fluorescent imaging (ICG-FI) has recently been introduced as an alternative tool, but so far a standardized quantitative assessment of tissue perfusion in vascular surgery has not been performed for this purpose. The aim of this feasibility study was to investigate a new software for quantitative assessment of tissue perfusion in patients with PAD using indocyanine green fluorescent imaging (ICG-FI) before and after peripheral bypass grafting. Patients and methods: Indocyanine green fluorescent imaging was performed in seven patients using the SPY Elite system before and after peripheral bypass grafting for PAD (Rutherford III-VI). Visual and quantitative evaluation of tissue perfusion was assessed in an area of low perfusion (ALP) and high perfusion (AHP), each by three independent investigators. Data assessment was performed offline using a specially customized software package (Institute for Laser Technology, University Ulm, GmbH). Slope of fluorescent intensity (SFI) was measured as time-intensity curves. Values were compared to ankle-brachial index (ABI), slope of oscillation (SOO), and time to peak (TTP) obtained from photoplethysmography (PPG). Results: All measurements before and after surgery were successfully performed, showing that ABI, TTP, and SOO increased significantly compared to preoperative values, all being statistically significant (P < 0.05), except for TTP (p = 0.061). Further, SFI increased significantly in both ALP and AHP (P < 0.05) and correlated considerably with ABI, TTP, and SOO (P < 0.05). Conclusions: In addition to ABI and slope of oscillation (SOO), the ICG-FI technique allows visual assessment in combination with quantitative assessment of tissue perfusion in patients with PAD. Ratios related to different perfusion patterns and SFI seem to be useful tools to reduce factors disturbing ICG-FI measurements.

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