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Is Lymphaticovenular Anastomosis Still Feasible When Indocyanine Green Lymphography Demonstrated Absence of �Linear� Patterns?
Shih-Lun Lo, Melis Salman, Berk B Ozmen, Wei F Chen
Cleveland Clinic
2025-01-10
Presenter: Melis Salman
Affidavit:
Represents original work of the two fellows based on my patients, not previously published or presented
Director Name: Wei F. Chen
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Purpose
The "linear" indocyanine green lymphography (ICGL) pattern is widely accepted as a prerequisite to successful lymphaticovenular anastomosis (LVA), with its absence considered a contraindication. However, studies suggest that absence of lymphographic patterns does not equate to true anatomic absence of lymph vessels. Given the anatomic parallel between the superficial lymphatic and venous systems, we tested a "follow-the-vein"(FV) approach in performing LVA and evaluated its effectiveness in comparison to the conventional "follow-the-linear"(FL) approach.
Methods
All patients who underwent LVA from January 2020 to December 2023 at Cleveland Clinic were included in the study, with the control group being those who demonstrated linear pattern on ICGL and the study group being those who demonstrated its absence. The surgical feasibility and outcomes were evaluated and compared with patient reported outcomes(PRO), surgical times and ICGL.
Results
Among 98 patients, 70 were in the FL-group, and 28 in the FV-group, with comparable demographics. The FL-group averaged 4.56 incisions and 7.2 anastomoses per procedure, with a 96.2% lymphatic channel success rate. The FV-group averaged 5.1 incisions and 8.7 anastomoses, with a 93% success rate. The FV-group had significantly more incisions and anastomoses, but surgical times showed no statistical difference. Both groups reported high satisfaction and significant improvements in edema, limb function, pain, and exercise tolerance. PRO improvements occurred in 97.1% of FL and 89.3% of FV-cases, with ICGL improvements in 94.3% and 96.4%, respectively.
Conclusions
The absence of a linear pattern in ICGL is not a contraindication for LVA. The "follow-the-vein" method provides a reliable alternative for patients without clear ICGL guidance.
