A novel method of measuring human lymphatic pumping using indocyanine green fluorescence lymphography Naoki Unno, MD, Motohiro Nishiyama, MD, Minoru.

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A novel method of measuring human lymphatic pumping using indocyanine green fluorescence lymphography Naoki Unno, MD, Motohiro Nishiyama, MD, Minoru Suzuki, MD, Hiroki Tanaka, MD, Naoto Yamamoto, MD, Daisuke Sagara, MD, Yuuki Mano, MD, Hiroyuki Konno, MD Journal of Vascular Surgery Volume 52, Issue 4, Pages 946-952 (October 2010) DOI: 10.1016/j.jvs.2010.04.067 Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 1 Measurement of lymphatic pumping in the lower leg wrapped with a custom-made transparent sphygmomanometer cuff with volunteers (A) supine or (B) sitting. Journal of Vascular Surgery 2010 52, 946-952DOI: (10.1016/j.jvs.2010.04.067) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 2 Indocyanine green fluorescence lymphography: (A) real-time images of stagnant lymph propulsion at the lower border of the cuff; (B) lymph propulsion moving across the lower border of the cuff; (C) lymph propulsion moving to the midpoint of the cuff; and (D) lymph propulsion moving across the upper border of the cuff. The arrows indicate the most advanced indocyanine green contrast agent in the lymph vessel, the solid line outlines the cuff, and the dotted line outlines the lower leg. Journal of Vascular Surgery 2010 52, 946-952DOI: (10.1016/j.jvs.2010.04.067) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 3 Measuring lymphatic pumping with lymphoscintigraphy. Lymphatic pumping was measured with the individual supine under the gamma camera. Sphygmomanometer cuffs were wrapped around the bilateral lower legs. Journal of Vascular Surgery 2010 52, 946-952DOI: (10.1016/j.jvs.2010.04.067) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 4 Typical case of a dynamic lymphoscintigraph of the lower leg. The circles indicate the site at the upper border of the cuff where the time-activity curves were created. At t = 23 min, with pressure of the cuff (Pcuff) at 20 mm Hg, the time-activity curve at the upper border of the cuff shows an elevation in number of counts per minute (arrow d), indicating that the lymph pumping pressure is 20 to 29 mm Hg. Panels a through f (top) correspond with arrowsa through f in the graph. Journal of Vascular Surgery 2010 52, 946-952DOI: (10.1016/j.jvs.2010.04.067) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 5 A, Correlation and (B) Bland-Altman Plots describe the relationship between the lymphatic pumping obtained by indocyanine green (ICG) fluorescence lymphography and dynamic lymphoscintigraphy. B, The Bland-Altman diagram shows the mean differences (solid line), and tolerance upper and lower 1.96 ± SD limits (dotted lines). Ppump, Lymphatic pumping pressure. Journal of Vascular Surgery 2010 52, 946-952DOI: (10.1016/j.jvs.2010.04.067) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 6 Comparison of lymphatic pumping in healthy legs and lymphedematous legs while volunteers were sitting. Data are shown as mean ± SD. Journal of Vascular Surgery 2010 52, 946-952DOI: (10.1016/j.jvs.2010.04.067) Copyright © 2010 Society for Vascular Surgery Terms and Conditions