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Updated: Sep 28, 2025
04:38
A Murine Tail Lymphedema Model
Published on: February 10, 2021
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Lymphaticovenular Anastomosis for Advanced-Stage Peripheral Lymphedema: Expanding Indication and Introducing the
Giuseppe Visconti1, Akitatsu Hayashi2, Alessandro Bianchi3
1Plastic Surgeon, Centre for Surgical Treatment of Lymphedema, UOC Chirurgia Plastica, Dipartmento di Scienze per la Salute della Donna, del Bambino e di Sanità Pubblica - Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma, Italy - Largo A. Gemelli 8, 00168 Rome, Italy.
Summary
Ultrasound (US) can identify functioning lymphatics for lymphaticovenular anastomosis (LVA) in advanced lymphedema. The "hand/foot sign" helps predict successful LVA by indicating preserved skin and likely functional lymphatic channels.
Area of Science:
- Vascular Surgery
- Lymphedema Management
- Diagnostic Imaging
Background:
- Effective lymphaticovenular anastomosis (LVA) relies on identifying functioning lymphatics, which are often obscured in advanced lymphedema using traditional contrast imaging.
- Ultrasound (US) offers a preoperative solution for visualizing lymphatic vessels, even in severe lymphedema cases.
- The
- hand/foot sign
- a novel clinical observation in advanced lymphedema patients, is explored for its diagnostic utility.
Purpose of the Study:
- To evaluate the efficacy of ultrasound (US) in identifying functioning lymphatic vessels for LVA in advanced lymphedema.
- To investigate the clinical significance of the
- hand/foot sign
- as a predictor of successful LVA.
- To assess outcomes of LVA in advanced lymphedema patients based on preoperative imaging and clinical signs.
Main Methods:
- Seventy-six advanced-stage secondary lymphedema patients underwent LVA between January 2016 and January 2019.
- Preoperative assessment included lymphoscintigraphy, indocyanine-green lymphography (ICG-L), and high-frequency US.
- Patient characteristics, the
- hand/foot sign
- , lymphatic degeneration, and 1-year follow-up outcomes (quantitative, qualitative, composite) were analyzed.
Main Results:
- An average of 3 LVAs were performed for upper limb lymphedema (47 patients) and 4 for lower limb lymphedema (29 patients).
- A positive composite outcome was observed in 59.7% of patients.
- A
- negative
- hand/foot sign correlated significantly with the presence of functioning lymphatic channels, while a positive sign was associated with higher adverse outcomes.
Conclusions:
- Ultrasound can identify salvageable lymphatic channels for LVA in patients where lymphoscintigraphy and ICG-L fail.
- The
- hand/foot sign
- serves as a valuable clinical indicator for predicting the likelihood of locating functional lymphatics for bypass surgery.
- LVA, guided by US and considering the hand/foot sign, offers a potential solution for advanced lymphedema.
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