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Lasso. Plast Aesthet Res 2020;7:30 Plastic and
DOI: 10.20517/2347-9264.2019.75 Aesthetic Research

Original Article Open Access

Lympho-SPECT/CT as a tool to evaluate
postoperative outcomes after LVA for lymphedema

repair

Jose M. Lasso

Plastic and Reconstructive Surgery, Hospital General Universitario Gregorio Marañón, Madrid 28007, Spain.

Correspondence to: Dr. Jose M. Lasso, Plastic and Reconstructive Surgery, Hospital General Universitario Gregorio Marañón, C/
Dr Esquerdo 46, Madrid 28007, Spain. E-mail: josemaria.lasso@salud.madrid.org
How to cite this article: Lasso JM. Lympho-SPECT/CT as a tool to evaluate postoperative outcomes after LVA for lymphedema
repair. Plast Aesthet Res 2020;7:30. http://dx.doi.org/10.20517/2347-9264.2019.75
Received: 23 Dec 2020 First Decision: 19 Mar 2020 Revised: 29 Apr 2020 Accepted: 4 Jun 2020 Published: 18 Jun 2020

Science Editor: Xiao Long Copy Editor: Cai-Hong Wang Production Editor: Jing Yu

Abstract
Aim: To describe findings when comparing lympho-SPECT-CT images before and after lymphovenous anastomosis
(LVA) surgeries and to correlate these results with pre- and post-operative volume changes in the limbs of
patients.

Methods: An observational, prospective, longitudinal study was designed. 20 consecutive patients were treated
for lymphedema by means of LVA between 2015 and 2018. All were affected by secondary lymphedema (ISG II-
III) following lymphadenectomy, radiation or both. All patients received preoperative rehabilitation as well as
radiotherapy after oncological surgery. Limb volume was measured before surgery and at one year later. LVA was
performed under general anesthesia with ICG guidance. ICG was also used to evaluate postoperative outcomes.
Lympho-SPECT-CT was performed in all subjects at their first consultation and at one year after every surgical
intervention. Description of findings included an absence of lymph nodes, new lymph node activity in anatomical
areas and new lymphatic activity in extra-anatomical areas.

Results: Limb volume decreased in 19 patients after LVA. Six patients showed preoperative linear ICG patterns,
combined with areas presenting with another type of pattern. After LVA, the linear pattern was observed in 11
patients. SPECT-CT/lymphoscintigraphy before surgery showed a total absence of lymph nodes, except in two
cases, in whom small nodes in anatomical locations were described. After LVA, we observed new landmarks in
16 patients corresponding to lymphatic circulation that was not present in preoperative studies. In six cases, new

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
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