Factors Associated with Lymphosclerosis: An Analysis on 962 Lymphatic Vessels

Area of Science:

• Vascular Surgery
• Lymphedema Management
• Microsurgery

Background:

• Lymphaticovenular anastomosis (LVA) is a key treatment for lower extremity lymphedema.
• Treatment success hinges on the degree of lymphosclerosis.
• Identifying factors predicting severe lymphosclerosis is crucial for optimizing LVA outcomes.

Purpose of the Study:

• To identify independent factors associated with severe lymphosclerosis in patients undergoing LVA.
• To correlate indocyanine green lymphography (ICG) findings with lymphosclerosis severity.
• To guide surgical planning for LVA in lymphedema patients.

Main Methods:

• Retrospective review of 134 patients with lower extremity lymphedema.
• Preoperative indocyanine green lymphography (ICG) and intraoperative assessment of lymphatic vessels.
• Classification of lymphosclerosis severity (s0-s3) based on intraoperative findings.
• Logistic regression analysis to determine factors associated with severe lymphosclerosis (s3).

Main Results:

• Severe lymphosclerosis (s3) was found in 10.1% of analyzed lymphatic vessels.
• Higher body mass index (BMI) was associated with increased odds of severe lymphosclerosis.
• Thigh/foot incision sites and specific ICG patterns (S-region, D-region) significantly correlated with severe lymphosclerosis.
• A history of radiation therapy showed an inverse association with severe lymphosclerosis.

Conclusions:

• Indocyanine green lymphography patterns are strongly associated with severe lymphosclerosis.
• Higher BMI, specific incision locations, and ICG D-region patterns predict severe lymphosclerosis.
• The D-region identified on ICG lymphography should be avoided during lymphaticovenular anastomosis procedures.