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Targeting Reflux-Free Veins with a Vein Visualizer to Identify the Ideal Recipient Vein Preoperatively for Optimal Lymphaticovenous Anastomosis in Treating Lymphedema

Yang, Johnson Chia-Shen M.D.; Wu, Shao-Chun M.D.; Chiang, Min-Hsien M.D.; Lin, Wei-Che M.D.

Plastic and Reconstructive Surgery: March 2018 - Volume 141 - Issue 3 - p 793-797
doi: 10.1097/PRS.0000000000004176
Reconstructive: Lower Extremity: Ideas and Innovations
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Summary: Lymphaticovenous anastomosis is one of the main surgical treatments nowadays for alleviating lymphedema. A successful lymphaticovenous anastomosis relies on being able to identify “functional” lymphatic collecting vessels that are still capable of transporting lymph, and a nearby vein that is, ideally, reflux-free. This is a retrospective study. A total of 28 lymphedema patients were enrolled from October of 2016 to March of 2017 in Kaohsiung Chang Gung Hospital, Kaohsiung, Taiwan. A noninvasive vein visualizer was used to preselect reflux-free veins for lymphaticovenous anastomosis from five female patients. As a control, the total number of veins used for lymphaticovenous anastomoses without the use of a vein visualizer from 23 consecutive lymphedema patients was also recorded and compared. In the experimental group, a total of 12 of 13 veins (92 percent sensitivity) preselected by using the VeinViewer were confirmed to be reflux-free intraoperatively during lymphaticovenous anastomosis. In the control group, 21 of 56 veins (37.5 percent sensitivity) showed no venous reflux. Statistical analysis with the chi-square test showed a value of p < 0.001 (number needed to treat = 2.706). The odds of identifying reflux-free veins can be increased significantly with the use of a vein visualizer.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, II.

Kaohsiung, Taiwan

From the Division of Plastic and Reconstructive Surgery, Department of Surgery, the Department of Anesthesiology, and the Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine.

Received for publication May 13, 2017; accepted October 4, 2017.

Presented at the 26th World Congress of Lymphology, in Barcelona, Spain, September 25 through 29, 2017.

Disclosure:The authors have no financial interest to disclose. No funding was received for this article.

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Johnson Chia-Shen Yang, M.D., Kaohsiung Chang Gung Memorial Hospital, 123 Dapi Road, Niaosong District, Kaohsiung, Taiwan 833, johnson.c.yang@gmail.com

Copyright © 2017 by the American Society of Plastic Surgeons