Lymphatic dysfunction after ligation surgery for varicose vein

Lymphatic flow restoration after stripping surgery for varicose veins: A case report

It has been suggested that the dynamics of the venous and lymphatic systems interact as a mutually dependent dual outflow system and that derangement of lymph flow could be reversed by surgical treatment of venous incompetence. In this report, we describe a patient in whom lymphatic function was restored after stripping of the great saphenous vein for varicosity. The patient was a 79-year-old woman who had varicose veins along the medial side of an edematous left leg. Lymphatic function was investigated using indocyanine green imaging to evaluate for the presence of lymphedema. Based on the findings, we made a diagnosis of bilateral varicosity of the great saphenous vein with left-sided lymphedema. The great saphenous vein was stripped between the groin and ankle on both sides. At 3 months after the stripping procedure, lymphatic flow was observed immediately after injection of indocyanine green in both legs along the medial side from the foot to the groin. We therefore determined that lymphatic flow had been restored after the stripping surgery. The functions of the venous and lymphatic systems are thought to be closely related, and that, if the function of one declines, the other will also be affected. Treatment of venous system, including stripping, may help to break the vicious cycle of lymphatic stasis and venous insufficiency.

Usefulness of preoperative echography for detection of lymphatic vessels for lymphaticovenous anastomosis

Case 1: A 63-year-old woman with secondary lower limb lymphedema. As it was difficult to detect the lymphatic vessels in the right thigh in indocyanine green lymphography because of thick fat, we tried echography and observed circular structures beneath the superficial fascia. Intraoperatively, we found a dilated lymphatic vessel just as observed on echography. Case 2: A 45-year-old woman with primary lower limb lymphedema. As she was allergic to iodinated contrast medium, we could not use indocyanine green lymphography preoperatively. In echography, we found vascular architectures and found the dilated lymphatic vessels intraoperatively just as observed on echography. In conclusion, application of echography in detecting the lymphatic vessels was useful as a preoperative examination of lymphaticovenous anastomosis.