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Lymphaticovenous Anastomosis for Age-Related Lymphedema

Introduction: Primary lymphedema is usually caused by intrinsic disruption or genetic damage to the lymphatics but may also be the result of age-related deterioration of the lymphatics. The aims of this study were to determine the characteristics of age-related lymphedema and to assess the effective...

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Autores principales: Yoshida, Shuhei, Koshima, Isao, Imai, Hirofumi, Roh, Solji, Mese, Toshiro, Uchiki, Toshio, Sasaki, Ayano, Nagamatsu, Shogo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8584733/
https://www.ncbi.nlm.nih.gov/pubmed/34768657
http://dx.doi.org/10.3390/jcm10215129
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author Yoshida, Shuhei
Koshima, Isao
Imai, Hirofumi
Roh, Solji
Mese, Toshiro
Uchiki, Toshio
Sasaki, Ayano
Nagamatsu, Shogo
author_facet Yoshida, Shuhei
Koshima, Isao
Imai, Hirofumi
Roh, Solji
Mese, Toshiro
Uchiki, Toshio
Sasaki, Ayano
Nagamatsu, Shogo
author_sort Yoshida, Shuhei
collection PubMed
description Introduction: Primary lymphedema is usually caused by intrinsic disruption or genetic damage to the lymphatics but may also be the result of age-related deterioration of the lymphatics. The aims of this study were to determine the characteristics of age-related lymphedema and to assess the effectiveness of lymphaticovenous anastomosis (LVA) in its treatment. Methods: Eighty-six patients with primary lymphedema affecting 150 lower limbs were divided into three groups according to whether the age of onset was younger than 35 years, 35–64 years, or 65 years or older. Indocyanine green (ICG) lymphography was performed, followed by LVA surgery. ICG lymphography images were visually classified according to whether the pattern was linear, low enhancement (LE), distal dermal backflow (dDB), or extended dermal backflow (eDB). The lower extremity lymphedema (LEL) index score was calculated before and after LVA. Lymphatic vessel diameter and detection rates were also recorded. Results: In the ≥65 group, the lymphedema was bilateral in 54 patients and unilateral in 1 patient. There was statistically significant deterioration in the LEL index score with progression from the linear, LE, dDB through to the eDB pattern in the ≥65 group. The lymphatic vessel diameter was significantly greater in the ≥65 group. The rate of improvement was highest in the ≥65 group. Conclusion: Age-related lymphedema was bilateral and deterioration started distally. The lymphatic vessels in patients with age-related lymphedema tended to be ectatic, which is advantageous for LVA and may increase the improvement rate.
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spelling pubmed-85847332021-11-12 Lymphaticovenous Anastomosis for Age-Related Lymphedema Yoshida, Shuhei Koshima, Isao Imai, Hirofumi Roh, Solji Mese, Toshiro Uchiki, Toshio Sasaki, Ayano Nagamatsu, Shogo J Clin Med Article Introduction: Primary lymphedema is usually caused by intrinsic disruption or genetic damage to the lymphatics but may also be the result of age-related deterioration of the lymphatics. The aims of this study were to determine the characteristics of age-related lymphedema and to assess the effectiveness of lymphaticovenous anastomosis (LVA) in its treatment. Methods: Eighty-six patients with primary lymphedema affecting 150 lower limbs were divided into three groups according to whether the age of onset was younger than 35 years, 35–64 years, or 65 years or older. Indocyanine green (ICG) lymphography was performed, followed by LVA surgery. ICG lymphography images were visually classified according to whether the pattern was linear, low enhancement (LE), distal dermal backflow (dDB), or extended dermal backflow (eDB). The lower extremity lymphedema (LEL) index score was calculated before and after LVA. Lymphatic vessel diameter and detection rates were also recorded. Results: In the ≥65 group, the lymphedema was bilateral in 54 patients and unilateral in 1 patient. There was statistically significant deterioration in the LEL index score with progression from the linear, LE, dDB through to the eDB pattern in the ≥65 group. The lymphatic vessel diameter was significantly greater in the ≥65 group. The rate of improvement was highest in the ≥65 group. Conclusion: Age-related lymphedema was bilateral and deterioration started distally. The lymphatic vessels in patients with age-related lymphedema tended to be ectatic, which is advantageous for LVA and may increase the improvement rate. MDPI 2021-10-31 /pmc/articles/PMC8584733/ /pubmed/34768657 http://dx.doi.org/10.3390/jcm10215129 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Yoshida, Shuhei
Koshima, Isao
Imai, Hirofumi
Roh, Solji
Mese, Toshiro
Uchiki, Toshio
Sasaki, Ayano
Nagamatsu, Shogo
Lymphaticovenous Anastomosis for Age-Related Lymphedema
title Lymphaticovenous Anastomosis for Age-Related Lymphedema
title_full Lymphaticovenous Anastomosis for Age-Related Lymphedema
title_fullStr Lymphaticovenous Anastomosis for Age-Related Lymphedema
title_full_unstemmed Lymphaticovenous Anastomosis for Age-Related Lymphedema
title_short Lymphaticovenous Anastomosis for Age-Related Lymphedema
title_sort lymphaticovenous anastomosis for age-related lymphedema
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8584733/
https://www.ncbi.nlm.nih.gov/pubmed/34768657
http://dx.doi.org/10.3390/jcm10215129
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