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Use of Indocyanine Green-SPY Angiography for Tracking Lymphatic Recovery After Lymphaticovenous Anastomosis

Shih, Hubert B. MD; Shakir, Afaaf BS; Nguyen, Dung H. MD

doi: 10.1097/SAP.0000000000000766
Clinical Papers

Introduction Lymphaticovenous anastomosis (LVA) is a surgical treatment option for patients with early stage lymphedema. To date, no ideal imaging modality exists for tracking patency of the LVA postoperatively. We hypothesize that laser angiography utilizing indocyanine green (ICG) via the SPY system (Lifecell Corp.) would be a useful methodology for assessing the patency of the LVA and lymphatic recovery postoperatively.

Methods A prospective trial was performed on patients with stage II lymphedema who underwent LVA from 2013 to 2014 by a single surgeon. All candidates underwent preoperative and postoperative lymphatic mapping using ICG-SPY angiography. Postoperative analyses were performed at 1 month and at 9 months after surgery and assessed for patency at the site of the LVAs and for changes in lymphatic pattern.

Results Five patients underwent LVA, 3 for upper extremity and 2 for lower extremity stage II lymphedema. The number of LVAs per extremity was 1 to 3 (total, 11). One month postoperative ICG-SPY angiography demonstrated flow through 9 of 11 anastomoses. Evaluation at 9 months postoperative showed improvement in lymphatic drainage.

Conclusions Indocyanine green-SPY angiography may be used to objectively evaluate the surgical outcome of LVA.

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From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford Hospital and Clinics, Stanford, CA.

Received October 12, 2015, and accepted for publication, after revision January 11, 2016.

Conflicts of interest and source of funding: none declared.

Reprints: Hubert B. Shih, MD, 770 Welch Road, Suite 400, Stanford, CA 94304. E-mail:

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