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Usefulness of Preoperative Echography for Detection of Lymphatic Vessels for Lymphaticovenous Anastomosis

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Case Reports

Usefulness of Preoperative Echography for Detection of Lymphatic Vessels for Lymphaticovenous Anastomosis

Hisako Hara et al. SAGE Open Med Case Rep.

Abstract

Case 1: A 63-year-old woman with secondary lower limb lymphedema. As it was difficult to detect the lymphatic vessels in the right thigh in indocyanine green lymphography because of thick fat, we tried echography and observed circular structures beneath the superficial fascia. Intraoperatively, we found a dilated lymphatic vessel just as observed on echography. Case 2: A 45-year-old woman with primary lower limb lymphedema. As she was allergic to iodinated contrast medium, we could not use indocyanine green lymphography preoperatively. In echography, we found vascular architectures and found the dilated lymphatic vessels intraoperatively just as observed on echography. In conclusion, application of echography in detecting the lymphatic vessels was useful as a preoperative examination of lymphaticovenous anastomosis.

Keywords: Lymphedema; echography; lymphatic vessel; lymphaticovenous anastomosis; ultrasonography.

Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
(a) Preoperative appearance of Case 1. Obvious edema can be observed in the bilateral legs. (b) Clinical appearance of Case 1, 7 months after lymphatic venous anastomosis. The condition of the lymphedema is improved. (c) Lymphoscintigraphic finding in Case 1. Radioisotope was injected in the bilateral dorsum of the foot. Many dilated lymphatic vessels and dermal backflow are observed in the bilateral legs.
Figure 2.
Figure 2.
The preoperative echographic finding and intraoperative finding in the lymphaticovenous anastomosis (LVA) in Case 1. Blue arrow: subcutaneous vein; yellow arrow: collecting lymphatic vessel; and white arrow: superficial fascia. (a) Preoperative echographic finding in the right thigh. A circular structure which was thought to be the lymphatic vessel is observed beneath the superficial fascia. (b) Intraoperative finding in the right thigh. The subcutaneous vein and collecting lymphatic vessel can be observed just as on echography and we could anastomose them. The square in the green background indicates 1 mm.
Figure 3.
Figure 3.
(a) Preoperative appearance of Case 2. Edema can be observed in the left leg. (b) Lymphoscintigraphic finding of Case 2. Radioisotope was injected in the bilateral dorsum of the foot. Linear lymphatic vessels and inguinal lymph nodes can be observed in the right leg. The left lower leg and thigh shows dermal backflow. The number of inguinal lymph nodes is limited.
Figure 4.
Figure 4.
Preoperative echographic finding and intraoperative findings in lymphaticovenous anastomosis (LVA) in Case 2. Blue arrow: subcutaneous vein; yellow arrow: collecting lymphatic vessel; and white arrow: superficial fascia. (a) Preoperative echographic finding in the left proximal thigh in Case 2. A circular structure can be observed beneath the superficial fascia and seems to be the lymphatic vessel. (b) Preoperative echographic finding in the left distal thigh in Case 2. (c) Intraoperative finding in the left proximal thigh. The subcutaneous vein and collecting lymphatic vessel can be observed just as on echography and we could anastomose them. The square in the green background indicates 1 mm. Lymphatic fluid flowing into the vein is shown. (d) Intraoperative finding in the left distal thigh. The square in the green background indicates 1 mm. Lymphatic fluid flows into the vein.

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References

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