LYMPHOSCINTIGRAPHIC ASSESSMENT OF LEG EDEMA FOLLOWING ARTERIAL RECONSTRUCTION USING A LOAD PRODUCED BY STANDING

Lymphoscintigraphy using a test involving standing from a supine position and performed following an intradermal injection of Tc-99m-human serum albumin (HSA) was developed to evaluate the function of the lymphatic system in the lower extremities of patients who developed lymphoedema following arterial reconstructive surgery. In normal subjects, the load produced by standing tended to increase lymphatic function as indicated by the frequent appearance of a large spiking wave and a rapid stepwise increase in tracer activity and, less often, a phase of decreasing tracer activity. However, there was either no or less activation of lymph flow following standing in the group which developed leg oedema postoperatively. These findings indicate that lymphatic disruption is responsible for the leg oedema seen in these patients. Performance of this test following an intradermal injection of Tc-99m-HSA is technically simple, requires no special apparatus, and can be completed in 30 min. Lymphoscintigraphy using our new method can provide useful information on abnormalities in lymphatic function.