The Intravascular Stenting Method for Treatment of Extremity Lymphedema with Multiconfiguration Lymphaticovenous Anastomoses
Identifieur interne : 000273 ( PascalFrancis/Corpus ); précédent : 000272; suivant : 000274The Intravascular Stenting Method for Treatment of Extremity Lymphedema with Multiconfiguration Lymphaticovenous Anastomoses
Auteurs : Mitsunaga Narushima ; Makoto Mihara ; Yusuke Yamamoto ; Takuya Iida ; Isao Koshima ; Gerhard S. MundingerSource :
- Plastic and reconstructive surgery : (1963) [ 0032-1052 ] ; 2010.
Descripteurs français
- Pascal (Inist)
English descriptors
Abstract
Background: In secondary extremity lymphedema, normal antegrade lymphatic flow is disrupted by the disease state. Attempts to capture aberrant retrograde lymphatic flow by means of microsurgical lymphaticovenous anastomoses have been hindered because of technical limitations. The authors applied the intravascular stenting method to the surgical correction of extremity lymphedema to generate multiconfiguration lymphaticovenous anastomoses capable of decompressing both proximal and distal lymphatic flow. Methods: Lymphatic channels were detected using indocyanine green injection and infrared scope imaging. Sites felt to be adequate for lymphaticovenous anastomosis were accessed through 2-cm skin incisions under local anesthesia. Using the intravascular stenting method, the authors performed a total of 39 lymphaticovenous anastomoses (15 flow-through, 11 end-to-end, eight end-to-side, two double end-to-end, two end-to-end/end-to-side, and one π-type) on both the proximal and distal ends of lymphatic channels in 14 female patients with upper (n = 2) and lower (n = 12) extremity lymphedema. Results: At an average follow-up of 8.9 months, average limb girth decreased 3.6 cm (range, 1.5 to 7 cm) or 11.3 percent (range, 4 to 33 percent). There was a greater reduction in cross-sectional area with increasing number of lymphaticovenous anastomoses per limb. Conclusions: The intravascular stenting method facilitated multiconfiguration lymphaticovenous anastomoses capable of decompressing both antegrade and retrograde lymphatic flow. This approach resulted in durable reduction of both upper and lower extremity lymphedema. As multiconfiguration lymphaticovenous anastomoses are now technically feasible, the influence of the number of lymphaticovenous anastomoses and the effectiveness of specific lymphaticovenous anastomosis configurations for the treatment of lymphedema deserves further study.
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Format Inist (serveur)
NO : | PASCAL 10-0157410 INIST |
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ET : | The Intravascular Stenting Method for Treatment of Extremity Lymphedema with Multiconfiguration Lymphaticovenous Anastomoses |
AU : | NARUSHIMA (Mitsunaga); MIHARA (Makoto); YAMAMOTO (Yusuke); IIDA (Takuya); KOSHIMA (Isao); MUNDINGER (Gerhard S.) |
AF : | Department of Plastic and Reconstructive Surgery, Tokyo University School of Medicine/Japon; Division of Plastic, Reconstructive, and Maxillofacial Surgery, Johns Hopkins Hospital/Etats-Unis |
DT : | Publication en série; Niveau analytique |
SO : | Plastic and reconstructive surgery : (1963); ISSN 0032-1052; Etats-Unis; Da. 2010; Vol. 125; No. 3; Pp. 935-943; Bibl. 50 ref. |
LA : | Anglais |
EA : | Background: In secondary extremity lymphedema, normal antegrade lymphatic flow is disrupted by the disease state. Attempts to capture aberrant retrograde lymphatic flow by means of microsurgical lymphaticovenous anastomoses have been hindered because of technical limitations. The authors applied the intravascular stenting method to the surgical correction of extremity lymphedema to generate multiconfiguration lymphaticovenous anastomoses capable of decompressing both proximal and distal lymphatic flow. Methods: Lymphatic channels were detected using indocyanine green injection and infrared scope imaging. Sites felt to be adequate for lymphaticovenous anastomosis were accessed through 2-cm skin incisions under local anesthesia. Using the intravascular stenting method, the authors performed a total of 39 lymphaticovenous anastomoses (15 flow-through, 11 end-to-end, eight end-to-side, two double end-to-end, two end-to-end/end-to-side, and one π-type) on both the proximal and distal ends of lymphatic channels in 14 female patients with upper (n = 2) and lower (n = 12) extremity lymphedema. Results: At an average follow-up of 8.9 months, average limb girth decreased 3.6 cm (range, 1.5 to 7 cm) or 11.3 percent (range, 4 to 33 percent). There was a greater reduction in cross-sectional area with increasing number of lymphaticovenous anastomoses per limb. Conclusions: The intravascular stenting method facilitated multiconfiguration lymphaticovenous anastomoses capable of decompressing both antegrade and retrograde lymphatic flow. This approach resulted in durable reduction of both upper and lower extremity lymphedema. As multiconfiguration lymphaticovenous anastomoses are now technically feasible, the influence of the number of lymphaticovenous anastomoses and the effectiveness of specific lymphaticovenous anastomosis configurations for the treatment of lymphedema deserves further study. |
CC : | 002B25; 002B12B04 |
FD : | Lymphoedème; Dilatation instrumentale; Chirurgie; Méthode; Traitement instrumental |
FG : | Pathologie de l'appareil circulatoire; Pathologie des vaisseaux lymphatiques |
ED : | Lymphedema; Instrumental dilatation; Surgery; Method; Instrumentation therapy |
EG : | Cardiovascular disease; Lymphatic vessel disease |
SD : | Linfedema; Dilatación instrumental; Cirugía; Método; Tratamiento instrumental |
LO : | INIST-11075.354000181833770220 |
ID : | 10-0157410 |
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Pascal:10-0157410Le document en format XML
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<author><name sortKey="Mihara, Makoto" sort="Mihara, Makoto" uniqKey="Mihara M" first="Makoto" last="Mihara">Makoto Mihara</name>
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<front><div type="abstract" xml:lang="en">Background: In secondary extremity lymphedema, normal antegrade lymphatic flow is disrupted by the disease state. Attempts to capture aberrant retrograde lymphatic flow by means of microsurgical lymphaticovenous anastomoses have been hindered because of technical limitations. The authors applied the intravascular stenting method to the surgical correction of extremity lymphedema to generate multiconfiguration lymphaticovenous anastomoses capable of decompressing both proximal and distal lymphatic flow. Methods: Lymphatic channels were detected using indocyanine green injection and infrared scope imaging. Sites felt to be adequate for lymphaticovenous anastomosis were accessed through 2-cm skin incisions under local anesthesia. Using the intravascular stenting method, the authors performed a total of 39 lymphaticovenous anastomoses (15 flow-through, 11 end-to-end, eight end-to-side, two double end-to-end, two end-to-end/end-to-side, and one π-type) on both the proximal and distal ends of lymphatic channels in 14 female patients with upper (n = 2) and lower (n = 12) extremity lymphedema. Results: At an average follow-up of 8.9 months, average limb girth decreased 3.6 cm (range, 1.5 to 7 cm) or 11.3 percent (range, 4 to 33 percent). There was a greater reduction in cross-sectional area with increasing number of lymphaticovenous anastomoses per limb. Conclusions: The intravascular stenting method facilitated multiconfiguration lymphaticovenous anastomoses capable of decompressing both antegrade and retrograde lymphatic flow. This approach resulted in durable reduction of both upper and lower extremity lymphedema. As multiconfiguration lymphaticovenous anastomoses are now technically feasible, the influence of the number of lymphaticovenous anastomoses and the effectiveness of specific lymphaticovenous anastomosis configurations for the treatment of lymphedema deserves further study.</div>
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<server><NO>PASCAL 10-0157410 INIST</NO>
<ET>The Intravascular Stenting Method for Treatment of Extremity Lymphedema with Multiconfiguration Lymphaticovenous Anastomoses</ET>
<AU>NARUSHIMA (Mitsunaga); MIHARA (Makoto); YAMAMOTO (Yusuke); IIDA (Takuya); KOSHIMA (Isao); MUNDINGER (Gerhard S.)</AU>
<AF>Department of Plastic and Reconstructive Surgery, Tokyo University School of Medicine/Japon; Division of Plastic, Reconstructive, and Maxillofacial Surgery, Johns Hopkins Hospital/Etats-Unis</AF>
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