Photoacoustic lymphangiography before and after lymphaticovenular anastomosis

Background

Lymphaticovenular anastomosis (LVA) is a minimally invasive surgical procedure used to treat lymphedema. Volumetric measurements and quality-of-life assessments are often performed to assess the effectiveness of LVA, but there is no method that provides information regarding postoperative morphological changes in lymphatic vessels and veins after LVA. Photoacoustic lymphangiography (PAL) is an optical imaging technique that visualizes the distribution of light-absorbing molecules, such as hemoglobin or indocyanine green (ICG), and provides three-dimensional images of superficial lymphatic vessels and the venous system simultaneously. In this study, we performed PAL in lymphedema patients before and after LVA and compared the images to evaluate the effect of LVA.

Methods

PAL was performed using the PAI-05 system in three patients (one man, two women) with lymphedema, including one primary case and two secondary cases, before LVA. ICG fluorescence lymphography was performed in all cases before PAL. Follow-up PAL was performed between 5 days and 5 months after LVA.

Results

PAL enabled the simultaneous visualization of clear lymphatic vessels that could not be accurately seen with ICG fluorescence lymphography and veins. We were also able to observe and analyze morphological changes such as the width and the number of lymphatic vessels and veins during the follow-up PAL after LVA.

Conclusions

By comparing preoperative and postoperative PAL images, it was possible to analyze the morphological changes in lymphatic vessels and veins that occurred after LVA. Our study suggests that PAL would be useful when assessing the effect of LVA surgery.

Keywords

Photoacoustic lymphangiography - Lymphaticovenular anastomosis - Lymphedema

This article was presented at the 10th Congress of World Society for Reconstructive Microsurgery on June 12-15, 2019, in Bologna, Italy.

Publication History

Received: 09 December 2020

Accepted: 04 February 2021

Article published online:
21 March 2022

• REFERENCES

• 1 Olszewski WL. The treatment of lymphedema of the extremities with microsurgical lympho-venous anastomoses. Int Angiol 1988; 07: 312-21
• 2 Campisi C, Boccardo F, Zilli A. et. al Long-term results after lymphatic-venous anastomoses for the treatment of obstructive lymphedema. Microsurgery 2001; 21: 135-09
• 3 O’Brien BM, Mellow CG, Khazanchi RK. et. al Long-term results after microlymphaticovenous anastomoses for the treatment of obstructive lymphedema. Plast Reconstr Surg 1990; 85: 562-72
• 4 Nagae K, Asao Y, Sudo Y. et. al Real-time 3D photoacoustic visualization system with a wide field of view for imaging human limbs. F1000Res 2018; 07: 1813
• 5 Kajita H, Oh A, Urano M. et. al Photoacoustic lymphangiography. J Surg Oncol 2020; 121: 48-50
• 6 Jiang X, Nicolls MR, Tian W. et. al Lymphatic dysfunction, leukotrienes, and lymphedema. Annu Rev Physiol 2018; 80: 49-70
• 7 Grada AA, Phillips TJ. Lymphedema: pathophysiology and clinical manifestations. J Am Acad Dermatol 2017; 77: 1009-20
• 8 Mortimer PS. The pathophysiology of lymphedema. Cancer 1998; 83 (Suppl. 12) 2798-802
• 9 Azhar SH, Lim HY, Tan BK. The unresolved pathophysiology of lymphedema. Front Physiol 2020; 11: 137
• 10 Rockson SG. Lymphedema. Am J Med 2001; 110: 288-95
• 11 Cucchi F, Rossmeislova L, Simonsen L. et. al A vicious circle in chronic lymphoedema pathophysiology? An adipocentric view. Obes Rev 2017; 18: 1159-69
• 12 Hespe GE, Nores GG, Huang JJ. et. al Pathophysiology of lymphedema: is there a chance for medication treatment?. J Surg Oncol 2017; 115: 96-08
• 13 Barone V, Borghini A, Tedone Clemente E. et. al New insights into the pathophysiology of primary and secondary lymphedema: histopathological studies on human lymphatic collecting vessels. Lymphat Res Biol 2020; 18: 502-09
• 14 Himeno Y, Ikebuchi M, Maeda A. et. al Mechanisms underlying the volume regulation of interstitial fluid by capillaries: a simulation study. Integr Med Res 2016; 5: 11-21