Indocyanine green near- infrared lymphangiography for evaluation of effectiveness of edema fluid flow under therapeutic compression

Indocyanine green near- infrared lymphangiography for evaluation of effectiveness of edema fluid flow under therapeutic compression:

Summary

The commonly used modalities for therapy of limb lymphedema are manual lymphatic drainage, manual devices moving edema fluid and intermittent pneumatic compression (IPC). What seems to be necessary for validation of the effect of the compression procedure is imaging of the mobilized moving edema fluid. Picture of edema fluid flow would allow the therapist to use force adjusted to the tissue volume and stiffness differing in various limb regions as well as identify sites of abundant accumulation of fluid requiring more compression. The purpose of the present study was visualise tissue edema fluid flow during manual drainage, Linforoll massage, intermittent pneumatic compression and bandaging. To obtain data how high compression pressures should be used to mobilize ICG stained fluid, concomitantly tissue fluid pressure measurements were done. The following observations were obtained: a) the possibility of real time observation of edema fluid movement using various compression modalities, b) the threshold pressures necessary to move edema fluid to be over 80 mmHg in the compression device and over 40 mmHg in the tissue fluid, c) inefficacy of compression in some cases despite of applying high compression force. These observations point to the need of ICG lymphangiography before compression therapy in each patient. The images observed during the compression procedure give an insight into the distribution of edema fluid, sites of its accumulation and efficacy of applied external force on fluid mobilization.

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