Lymphedema Evaluation and Treatment

A small amount (0.25 mg/0.1 mL) of ICG (Diagnogreen Injection, Daiichi Pharmaceutical, Tokyo, Japan) was injected subcutaneously into the first web space in upper extremity lymphedema, lateral malleolus, and the lateral side of the superior edge of the knee in lower extremity lymphedema. Furthermore, 12–18 h after the injection, we observed the ICG lymphography results using a near-infrared imaging device (Photodynamic Eye; Hamamatsu Photonics, Hamamatsu, Japan) and classified them into types Ⅰ to Ⅴ, as reported previously.¹⁷ (link) LVA was performed under local anesthesia in all cases along a linear pattern or along the ulnar side of the upper extremity in upper extremity lymphedema, and greater saphenous vein course in lower extremity lymphedema in the area of the dermal backflow pattern.⁵⁸ (link) The LVA procedures were performed in an end-to-end manner using 11-0 or 12-0 nylon micro sutures under a surgical microscope (Figures S4C and S4D).⁹ (link)

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Imai H., Kawase T., Yoshida S., Mese T., Roh S., Fujita A., Uchiki T., Sasaki A., Nagamatsu S., Takazawa A., Ichinohe T, & Koshima I. (2023). Peripheral T cell profiling reveals downregulated exhaustion marker and increased diversity in lymphedema post-lymphatic venous anastomosis. iScience, 26(6), 106822.

Publication 2023

Photodynamic Eye

Device Knee Local anesthesia Lower extremity Lymphedema Lymphography Microscope Nylon 12 Pharmaceutical Saphenous vein Surgical sutures Upper extremity

Corresponding Organization : Hiroshima University Hospital

Other organizations : Hiroshima University, Fujita Health University

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Variable analysis

independent variables

Amount of ICG (Diagnogreen Injection, Daiichi Pharmaceutical, Tokyo, Japan) injected subcutaneously (0.25 mg/0.1 mL)
Injection locations: first web space in upper extremity lymphedema, lateral malleolus, and the lateral side of the superior edge of the knee in lower extremity lymphedema

dependent variables

ICG lymphography results classified into types I to V using a near-infrared imaging device (Photodynamic Eye; Hamamatsu Photonics, Hamamatsu, Japan)
Lymphaticovenous anastomosis (LVA) procedure performed: linear pattern or along the ulnar side of the upper extremity in upper extremity lymphedema, and greater saphenous vein course in lower extremity lymphedema in the area of the dermal backflow pattern

control variables

Subcutaneous injection of ICG
Observation of ICG lymphography results 12-18 hours after injection
Performing LVA under local anesthesia in all cases
Using 11-0 or 12-0 nylon micro sutures for LVA under a surgical microscope

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