PMC6506910_01
The patient was a 79-year-old woman who had first become aware of edema in
her leg several years earlier. She presented to our clinic with a lower leg
edema below the knee. Lower extremity lymphedema (LEL) index was 179 on the
right and 173 on the left. There were varicose veins along the medial side
seen in the edematous leg. Clinical disease severity was graded C3 using the
revised CEAP (Clinical, Etiologic, Anatomic, and Pathophysiologic)
classification.
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She presented to our clinic with edema below the knee (Figure 1). Lymphatic flow was observed in the right leg along the medial side from the foot to the groin immediately within 3 min of injection of ICG; however, lymphatic flow was blocked and dilatation of the lymphatics was subsequently absent beyond the middle part of the left lower leg even with passive movement at the ankle and knee for over 10 min (Supplement Figure 1).
ICG image pre-operation.. Lymphatic flow was observed in the right leg along the medial side from
foot to groin immediately within 3 min after ICG injection; however, no
flow was observed beyond the middle part of the left lower leg even
after adding passive movement to the ankle and knee for over 10 min. At
3 h after ICG injection, there were no changes in ICG lymphography.
Right leg showed linear pattern, while the left leg showed less
enhancement pattern.
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The right leg showed a linear pattern, but the left leg showed less enhancement pattern (Figure 2).
The varicose veins were stripped successfully from ankle to groin
bilaterally. LEL index was 163 on the right and 162 on the left.
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The varicose veins were stripped successfully from the ankle to the groin bilaterally (Figure 3).