[Background] There is a need for a simple method for the quantitative evaluation of lymphedema swelling. In this study, we performed a direct segmental multi-frequency impedance analysis in patients with leg lymphedema.
[Methods] The subjects were 36 patients (6 men and 30 women) with 46 lymphedema legs. The average age was 61 years. All patients had International Society of Lymphology stageII lymphedema. Swelling ratio and ultrasound subcutaneous tissue echo-free space(FS) were examined. InBody 770 was used to measure the extracellular water (ECW), intracellular water (ICW), and total body water(TBW) volumes. Changes before and after complex decongestive treatment (CDT) were examined.
[Results] In 26 unilateral cases, the ECW, ICW, and TBW volumes of the affected legs were higher than those of the contralateral unaffected legs, and the ECW/TBW ratio was significantly higher in the affected legs (0.41) than in the contralateral unaffected legs (0.391). There was a significant correlation between the leg swelling ratio and the ECW/TBW ratio between the affected and contralateral unaffected legs (correlation coefficient=0.882). Ultrasound findings of the 46 affected legs were classified into no FS (group 0), minimal or only horizontal FS (group 1), and cobblestone-like FS (group 2). The ECW/TBW ratio of the affected legs in each group was 0.393 (14 legs), 0.407 (10 legs), and 0.426 (22 legs) respectively, demonstrating significant differences among the 3 groups. After CDT, the amount of water decreased in the affected legs and increased in the trunks and both upper limbs. The ECW/TBW ratio decreased significantly, from 0.432 to 0.414 in the affected legs, from 0.401 to 0.392 in the unaffected legs, and from 0.413 to 0.402 in the trunks. The ECW/TBW ratio had not changed and remained below 0.4 in the upper limbs.
[Conclusion] The segmental water contents measured by direct segmental multi-frequency impedance analysis correlates well with the degree of lymphedema swelling, and subcutaneous echo findings and can demonstrate water distribution change before and after CDT, which is considered to be a useful quantitative evaluation method for lymphedema.
Flush ligation of the small saphenous vein (SSV) is only performed in a limited number of institutions because of the technical difficulty of the procedure and the risk of neuropathy and deep vein damage. In this report, we propose the concept of ligation under knee-joint bending as an approach to facilitate flush ligation of the SSV. We applied the technique in the treatment of aneurysms localized near the sapheno-popliteal junction (SPJ).
[Subjects] The surgical procedure was performed in six cases of varicose veins with an aneurysm localized near the SPJ. Diameter of the aneurysm was ≥20 mm in three cases, and the distance to SPJ was ≤5 mm in five.
[Surgery method] Following the induction of a combination of tumescent local anesthesia and intravenous anesthesia, a 7-mm incision was made in the popliteal fossae. The SSV was exposed, ligated, and dissected. Once the proximal end of the SSV was raised and several branches were cut off without further dissection, the knee joint was bent ≥45°. This technique raised the SSV approximately 15 mm, making flush ligation easier to perform.
[Results] The mean surgical time was 37 minutes. In all six cases, high-level ligation was completed proximal to the aneurysm. No complications, such as neuropathy, deep vein thrombosis, and pulmonary embolism, were reported following surgery.
[Conclusion] The ligation under knee-joint bending technique was simple and safe and can, therefore, be widely applied in the future.
(Purpose) Strategies for the treatment of venous ulcers are currently under debate. (Objective) We retrospectively evaluated the treatment efficacy of venous ulcer cases. (Methods) In 917 consecutive patients (307 men and 610 women), endovascular ablation (EVA) was performed between December 2014 and January 2019. The mean patient age was 65.6. The rate of venous ulcer cases was 1.9% (17/917). The main treatment strategy was as follows: (1) varicectomy including incompetent perforating veins was performed using stab avulsion methods, (2) venous ulcer was washed in the shower and covered with dressings twice daily, and (3) compression therapy was maintained until full healing. (Results) In 17 patients receiving EVA, the mean operative time was 49.1 min, and the mean number of stab avulsion incisions was 12.9 sites. For three cases over 6 months, the remaining erosion was healed using steroid ointment. These 17 ulcers were healed within a median of 54 days (13–365). (Conclusion) EVA, adequate varicectomy, moist wound healing, and compression therapy healed all venous ulcers in approximately 2 months.