Multi-site lymphatic venous anastomosis using echography to detect suitable subcutaneous vein in severe lymphedema patients

Publication date: Available online 17 October 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Makoto Mihara, Hisako Hara, Yoshihisa Kawakami, Hang Peng Zhou, Shuichi Tange, Kazuki Kikuchi, Takuya Iida
BackgroundThe method of lymphatic venous anastomosis (LVA), including its indications or pre-operative examinations, has not been established. The purpose of this study is to reveal the possible application of pre-operative echography in surgical LVA outcome.MethodsWe performed a retrospective case-control study on patients with lower limb lymphedema who underwent LVA between August 15, 2013 and August 15, 2014. As a pre-operative examination, we introduced venous echography to identify subcutaneous veins in the echo group, and we only used Accuvein visualizing system in the control group. The operation time, number of anastomoses, and limb circumference were compared between the two groups.ResultsSeventeen patients (34 limbs) were included in the echo group, and 21 patients (42 limbs) were included in the control group. The average follow-up period was 11.9 (6-16) and 12.4 (6-27) months, respectively. The average operation time in the echo group was 258.6 minutes, and that in the control group was 216.5 minutes. The average number of anastomoses was 9.8 in the echo group and 7.0 in the control group. The average time per anastomosis in each group was 27.4 and 32.6 minutes, respectively. The diameter of the vein had a tendency to be larger in the echo group than in the control group. In 5.8 % of the echo group, we observed a circumference increase, compared with 23.8 % in the control group.ConclusionsPreoperative venous echography allowed surgeons to increase the number of anastomoses performed within the operating time, resulting in improvement of surgical outcomes.