Predictive role of lymphoscintigraphy undergoing lymphovenous anastomosis in patients with lower extremity lymphedema: a preliminary study

Abstract Background We investigated whether preoperative lymphoscintigraphy could predict the treatment response of unilateral lymphovenous anastomosis (LVA) in patients with lower extremity lymphedema. Materials and methods A total of 17 patients undergoing lymphoscintigraphy subsequent to LVA was included. As qualitative lymphoscintigraphic indicators, ilioinguinal lymph node uptake, main lymphatic vessel, collateral vessel, and four types of dermal backflow patterns (absent; distal only; proximal only; whole lower limb) were evaluated. Lymph node uptake ratio, extremity uptake ratio, and injection site clearance ratio were obtained as quantitative lymphoscintigraphic indicators at 1 and 2-h after injection. To evaluate therapy response, the volume difference ratio of the whole lower limb at 3 months (early response) and 1 year (late response) was measured. Volume difference ratios (continuous variable and binary variable with a cut-off value of zero) were compared according to the lymphoscintigraphic variables. Results The group with whole lower limb dermal backflow had a greater volume change than the other groups (p = 0.047). The group with dermal backflow in the whole lower limb OR only in the distal part had a higher rate of volume reduction than the group with dermal backflow only in the proximal part OR absent (p = 0.050). The 2-h extremity uptake ratio was the only indicator that positively correlated with early and late volume difference ratio (p = 0.016, p = 0.001). The rate of volume decrease at 1 year was high in patients with high 2-h extremity uptake ratio (p = 0.027). As the amount of dermal backflow increases, the postoperative therapeutic effect increases (p = 0.040). Conclusions Preoperative lymphoscintigraphy is useful to predict both early and late therapy response in patients with lower extremity lymphedema undergoing LVA. Both dermal backflow pattern and extremity uptake ratio may be predictive lymphoscintigraphic indicators.

Download Full-text

Predictive role of lymphoscintigraphy undergoing lymphovenous anastomosis in patients with lower extremity lymphedema

10.21203/rs.3.rs-948118/v1 ◽

2021 ◽

Author(s):

Hye Ryeong Kwon ◽

Ji Hye Hwang ◽

Goo-Hyun Mun ◽

Seung Hyup Hyun ◽

Seung Hwan Moon ◽

...

Keyword(s):

Lymph Node ◽

Lower Extremity ◽

Therapy Response ◽

Proximal Part ◽

Early Response ◽

Late Response ◽

Uptake Ratio ◽

Clearance Ratio ◽

Lymphovenous Anastomosis ◽

Volume Difference

Abstract Background We investigated whether preoperative lymphoscintigraphy could predict the treatment response of unilateral lymphovenous anastomosis (LVA) in patients with lower extremity lymphedema. Materials and methods A total of 17 patients undergoing lymphoscintigraphy subsequent to LVA was included. As qualitative lymphoscintigraphic indicators, ilioinguinal lymph node uptake, main lymphatic vessel, collateral vessel, and dermal backflow pattern were evaluated. Lymph node uptake ratio, extremity uptake ratio, and injection site clearance ratio were obtained as quantitative lymphoscintigraphic indicators at 1 and 2-h after injection. To evaluate therapy response, the volume difference ratio of the whole leg at 3 months (early response) and 1 year (late response) was measured. Results The group with whole leg dermal backflow had a greater volume change than the other groups (p=0.047). The group with dermal backflow in the whole leg OR only in the distal part had a higher rate of volume reduction than the group with dermal backflow only in the proximal part OR absent (p=0.050). The 2-h extremity uptake ratio was the only indicator that positively correlated with early and late volume difference ratio (p=0.016, p=0.001). The rate of volume decrease at 1 year was high in patients with high 2-h extremity uptake ratio (p=0.027). As the amount of dermal backflow increases, the postoperative therapeutic effect increases (p=0.040). Conclusions Preoperative lymphoscintigraphy is useful to predict both early and late therapy response in patients with lower extremity lymphedema undergoing LVA. Both dermal backflow pattern and extremity uptake ratio may be predictive lymphoscintigraphic indicators.

Download Full-text

Simultaneous Supraclavicular Lymph Node Transfer and Lymphovenous Anastomosis for the Surgical Treatment of End-Stage Lymphedema

10.21203/rs.3.rs-278654/v1 ◽

2021 ◽

Author(s):

Kyung-Chul Moon ◽

In-Jae Yoon

Keyword(s):

Lymph Node ◽

Lower Extremity ◽

Nonsurgical Management ◽

Inguinal Area ◽

History Of ◽

Lymph Node Transfer ◽

Lymphovenous Anastomosis ◽

The Right ◽

End Stage ◽

Vascularized Lymph Node Transfer

Abstract BackgroundVarious surgical options are available to treat lymphedema, such as direct excisional debulking surgery, suction-assisted lipectomy debulking, lymphovenous anastomosis (LVA), and vascularized lymph node transplantation (VLNT). However, no studies have addressed simultaneous surgery with both LVA and VLNT for patients with advanced-stage lymphedema. Case Presentation A 72-year-old female with bilateral lower extremity lymphedema refractory to nonsurgical management was admitted to our lymphedema clinic. This patient had a history of lymphoma and treated with radiotherapy on right inguinal area 26 years ago. Interestingly, the patient developed lymphedema on both the right and left lower extremities although she had radiotherapy on her right inguinal area. The patient underwent simultaneous vascularized lymph node transfer and lymphovenous anastomosis for treatment of end-stage lymphedema. Significant reduction in circumference and volume of lower extremity was achieved following simultaneous vascularized lymph node transfer and lymphonvenous anastomosis Conclusion The authors recommend simultaneous VLNT and LVA surgeries as the first treatment option for patients with end-stage lymphedema.

Download Full-text

Prospective evaluation of sentinel node navigation surgery in Japanese patients with low-risk endometrial cancer—safety and occurrence of lymphedema

Japanese Journal of Clinical Oncology ◽

10.1093/jjco/hyaa252 ◽

2021 ◽

Author(s):

Hitoshi Niikura ◽

Asami Toki ◽

Tomoyuki Nagai ◽

Satoshi Okamoto ◽

Shogo Shigeta ◽

...

Keyword(s):

Endometrial Cancer ◽

Lymph Node ◽

Sentinel Lymph Node ◽

Sentinel Lymph Node Biopsy ◽

Lymph Node Metastasis ◽

Lower Extremity ◽

Lymph Node Biopsy ◽

Occurrence Rate ◽

Node Metastasis ◽

Node Biopsy

Abstract Objective The present study aimed to clarify the occurrence rate of lymphedema and prognosis in patients with endometrial cancer according to sentinel lymph node biopsy alone with intraoperative histopathological examination. Methods The study included 45 consecutive patients with endometrial cancer treated at Tohoku University Hospital between October 2014 and August 2017. All patients had endometrial carcinoma with endometrioid histology Grade 1 or Grade 2 confirmed by biopsy and stage I on magnetic resonance imaging and/or computed tomography at their preoperative evaluation. Sentinel lymph node detection was performed by radioisotope and dye. Patients who were diagnosed intraoperatively as negative for sentinel lymph node metastasis did not undergo further systematic pelvic lymphadenectomy. The occurrence rate of lymphedema and prognosis was evaluated. Results Bilateral sentinel lymph nodes were detected in 44 of 45 patients (97%). Forty-three patients underwent sentinel lymph node biopsy alone, and only two patients underwent systematic lymphadenectomy. Sentinel lymph node metastases were detected in one patient intraoperatively and two patients postoperatively as ITCs. No patients experienced recurrence. New symptomatic lower-extremity lymphedema was identified in one of 43 patients (2.3%) who underwent sentinel lymph node biopsy alone. Conclusion Sentinel lymph node biopsy alone with intraoperative histopathological diagnosis appears to be a safe and effective strategy to detect lymph node metastasis and to reduce the number of patients with lower-extremity lymphedema among patients with endometrial cancer.

Download Full-text

Vascularized Lymph Node Transfer for Surgical Treatments of Upper Versus Lower Extremity Lymphedema

Journal of Vascular Surgery Venous and Lymphatic Disorders ◽

10.1016/j.jvsv.2021.05.012 ◽

2021 ◽

Author(s):

Kyung-Chul Moon ◽

Hyung-Kyu Kim ◽

Tae-Yul Lee ◽

Hi-Jin You ◽

Deok-Woo Kim

Keyword(s):

Lymph Node ◽

Lower Extremity ◽

Lymph Node Transfer ◽

Surgical Treatments ◽

Vascularized Lymph Node Transfer

Download Full-text

Limitations of body mass index for counseling individuals with unilateral lower extremity amputation

Prosthetics and Orthotics International ◽

10.1177/0309364616650079 ◽

2016 ◽

Vol 41 (2) ◽

pp. 186-193 ◽

Cited By ~ 3

Author(s):

Alexandra P Frost ◽

Tracy Norman Giest ◽

Allison A Ruta ◽

Teresa K Snow ◽

Mindy Millard-Stafford

Keyword(s):

Body Mass Index ◽

Lower Extremity ◽

Health Risk ◽

Body Mass ◽

Body Fat ◽

Lower Limb ◽

Dual Energy ◽

Limb Loss ◽

Percent Body Fat ◽

X Ray

Background: Body composition is important for health screening, but appropriate methods for unilateral lower extremity amputees have not been validated. Objectives: To compare body mass index adjusted using Amputee Coalition equations (body mass index–Amputee Coalition) to dual-energy X-ray absorptiometry in unilateral lower limb amputees. Study design: Cross-sectional, experimental. Methods: Thirty-eight men and women with lower limb amputations (transfemoral, transtibial, hip disarticulation, Symes) participated. Body mass index (mass/height2) was compared to body mass index corrected for limb loss (body mass index–Amputee Coalition). Accuracy of classification and extrapolation of percent body fat with body mass index was compared to dual-energy X-ray absorptiometry. Results: Body mass index–Amputee Coalition increased body mass index (by ~ 1.1 kg/m2) but underestimated and mis-classified 60% of obese and overestimated 100% of lean individuals according to dual-energy X-ray absorptiometry. Estimated mean percent body fat (95% confidence interval) from body mass index–Amputee Coalition (28.3% (24.9%, 31.7%)) was similar to dual-energy X-ray absorptiometry percent body fat (29.5% (25.2%, 33.7%)) but both were significantly higher ( p < 0.05) than percent body fat estimated from uncorrected body mass index (23.6% (20.4%, 26.8%)). However, total errors for body mass index and body mass index–Amputee Coalition converted to percent body fat were unacceptably large (standard error of the estimate = 6.8%, 6.2% body fat) and the discrepancy between both methods and dual-energy X-ray absorptiometry was inversely related ( r = −0.59 and r = −0.66, p < 0.05) to the individual’s level of body fatness. Conclusions: Body mass index (despite correction) underestimates health risk for obese patients and overestimates lean, muscular individuals with lower limb amputation. Clinical relevance Clinical recommendations for an ideal body mass based on body mass index–Amputee Coalition should not be relied upon in lower extremity amputees. This is of particular concern for obese lower extremity amputees whose health risk might be significantly underestimated based on body mass index despite a “correction” formula for limb loss.

Download Full-text

Vascularized lymph node transfer from thoracodorsal axis for congenital and post filarial lymphedema of the lower limb

Journal of Surgical Oncology ◽

10.1002/jso.24374 ◽

2016 ◽

Vol 115 (1) ◽

pp. 78-83

Author(s):

Hari Venkatramani ◽

Senthil Kumaran ◽

Shivannaiah Chethan ◽

Shanmuganathan Raja Sabapathy

Keyword(s):

Lymph Node ◽

Lower Limb ◽

Lymph Node Transfer ◽

Vascularized Lymph Node Transfer

Download Full-text

Infra-popliteal deep venous thrombi and the risk of symptomatic pulmonary embolism in hospitalized patients

Vascular ◽

10.1258/vasc.2010.oa0252 ◽

2011 ◽

Vol 19 (1) ◽

pp. 29-33 ◽

Cited By ~ 5

Author(s):

Saadi Alhalbouni ◽

Anil Hingorani ◽

Alexander Shiferson ◽

Natalie Marks ◽

Enrico Ascher

Keyword(s):

Pulmonary Embolism ◽

Lower Extremity ◽

Retrospective Review ◽

Lower Limb ◽

Hospitalized Patients ◽

Symptomatic Pulmonary Embolism ◽

Number Of Patients ◽

Significant Difference ◽

Hospital Patients ◽

Made In

Infra-popliteal veins include the tibial and peroneal veins, as well as the soleal and gastrocnemial veins collectively known as the calf muscle veins (CMVs). Acute infra-popliteal deep venous thrombi (DVTs) are often considered insignificant with regard to the risk of pulmonary embolism (PE). A retrospective review of 4035 consecutive lower extremity venous duplex scans were made in 3146 hospital patients at our Intersocietal Commission for the Accreditation of Vascular Laboratories (ICAVL)-accredited vascular lab. Seven hundred sixteen (17.7%) duplex scans were positive for acute DVTs, and 112 (2.8%) were associated with PEs. The breakdown of positive duplexes for acute DVTs was as follows: 202 (28.2%) isolated femoral-popliteal DVTs with PE in 23 (11.4%), 304 (42.5%) isolated infra-popliteal DVTs with PE in 24 (7.9%) and 210 (29.3%) multilevel DVTs involving both vein segments (femoral-popliteal and infra-popliteal) with PE in 38 (18.1%). Of the 304 isolated acute infra-popliteal DVTs, 207 (68.1%) were isolated CMV DVTs with evidence of PE in 12 (5.8%). No statistically significant difference ( P = 0.27) in the risk of PE between isolated femoral-popliteal and isolated infra-popliteal DVTs was noted. A significant number of patients (5.8%) with isolated CMV DVTs developed PE. Lower limb venous scans for DVTs should evaluate the infra-popliteal veins. Hospitalized patients with infra-popliteal DVTs should receive anticoagulation.

Download Full-text