{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T19:16:50Z","timestamp":1777922210537,"version":"3.51.4"},"reference-count":22,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2023,10,1]],"date-time":"2023-10-01T00:00:00Z","timestamp":1696118400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Lymphatic Research and Biology"],"published-print":{"date-parts":[[2023,10,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The axillo-inguinal (or inguino-axillary) is a compensatory lymphatic drainage pathway regularly utilized by lymphedema therapists when applying manual lymphatic drainage (MLD) for upper and lower extremity lymphedema. However, there is limited evidence of the frequency of this pathway and the characteristics of patients with lymphedema in which this pathway is present. Indocyanine green (ICG) lymphography is an imaging technique that has the capability to identify lymphatic drainage pathways in lymphedema when combined with MLD. In this study, we used ICG lymphography in patients with upper and lower extremity lymphedema to investigate the presence of this pathway and its clinical characteristics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and Results:<\/jats:title>\n                    <jats:p>A retrospective cohort audit of 563 patients with lymphedema (285 with upper extremity and 278 with lower extremity) who underwent ICG lymphography was conducted in combination with MLD. Compensatory lymphatic drainage was investigated. Patients demonstrating the axillo-inguinal pathway were identified, and their clinical characteristics were recorded. The axillo-inguinal pathway was not demonstrated in any patient with upper extremity and only five patients with lower extremity lymphedema. Of these five patients, all were female with a history of secondary cancer-related lymphedema following gynecological cancer. The majority (four) had bilateral lymphedema extending to the lower abdomen and presented with a greater severity of lymphedema.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>These findings suggest that the axillo-inguinal pathway is an infrequent compensatory drainage pathway in lower extremity lymphedema and rare in upper extremity lymphedema. Our findings have clinical implications for lymphedema management, in particular, the sequence in which MLD is applied.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/lrb.2022.0014","type":"journal-article","created":{"date-parts":[[2023,3,23]],"date-time":"2023-03-23T10:31:44Z","timestamp":1679567504000},"page":"495-500","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["The Prevalence of the Axillo-Inguinal Lymphatic Pathway in Lymphedema of the Extremities and Potential Therapeutic Implications"],"prefix":"10.1177","volume":"21","author":[{"given":"Helen","family":"Mackie","sequence":"first","affiliation":[{"name":"Australian Lymphoedema Education, Research and Treatment (ALERT), Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia."},{"name":"Mt Wilga Lymphoedema Service, Mt Wilga Private Hospital, Hornsby, New South Wales, Australia."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Belinda","family":"Thompson","sequence":"additional","affiliation":[{"name":"Australian Lymphoedema Education, Research and Treatment (ALERT), Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Asha","family":"Heydon-White","sequence":"additional","affiliation":[{"name":"Australian Lymphoedema Education, Research and Treatment (ALERT), Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroo","family":"Suami","sequence":"additional","affiliation":[{"name":"Australian Lymphoedema Education, Research and Treatment (ALERT), Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robbie","family":"Blackwell","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Louise","family":"Koelmeyer","sequence":"additional","affiliation":[{"name":"Australian Lymphoedema Education, Research and Treatment (ALERT), Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2023,10,17]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0142(19981215)83:12B <2798::AID-CNCR28>3.0.CO;2-E"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1002\/jso.24332"},{"key":"e_1_3_4_4_2","first-page":"1","article-title":"Using lymphoscintigraphy as a prognostic tool in patients with cancer","volume":"6","author":"Vidal-Sicart S","year":"2016","unstructured":"Vidal-Sicart S, , Olmos R. Using lymphoscintigraphy as a prognostic tool in patients with cancer. Res Rep Nucl Med, 2016; 6:1\u201317.","journal-title":"Res Rep Nucl Med"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.3390\/cancers12051338"},{"key":"e_1_3_4_6_2","unstructured":"F\u00f6ldi M F\u00f6ldi E Str\u00f6ssenreuther RHK Kubik S. F\u00f6ldi's Textbook of Lymphology: For Physicians and Lymphedema Therapists 3rd ed. M\u00fcnchen: Elsevier Urban & Fischer; 2012."},{"key":"e_1_3_4_7_2","unstructured":"Jenns K Twycross RG Todd J. Lymphoedema. Oxon UK: Radcliffe Medical Press Ltd.; 2000."},{"key":"e_1_3_4_8_2","doi-asserted-by":"crossref","unstructured":"Zuther JE Norton S Armer JM. Lymphedema Management: The Comprehensive Guide for Practitioners. New York: Thieme Medical Publishers Incorporated; 2012.","DOI":"10.1055\/b-0034-91077"},{"key":"e_1_3_4_9_2","first-page":"279","article-title":"Lower Limb Lymphedema. In: Lee BB, Bergan J, Rockson SG, eds. Lymphedema: A Concise Compendium of Theory and Practice","author":"Szolnoky G","year":"2011","unstructured":"Szolnoky G. Lower Limb Lymphedema. In: Lee BB, Bergan J, Rockson SG, eds. Lymphedema: A Concise Compendium of Theory and Practice. London: Springer London;, 2011:279\u2013285.","journal-title":"London: Springer London;"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11764-020-00928-1"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.12968\/bjcn.2010.15.Sup3.47365"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2010.12.027"},{"key":"e_1_3_4_13_2","first-page":"62","article-title":"A new dynamique imaging tool to study lymphoedema and associated treatments","volume":"22","author":"Giacalone G","year":"2011","unstructured":"Giacalone G, , Belgrado J-P, , Bourgeois P, , Bracale P, , R\u00f6h N, , Moraine JJ. A new dynamique imaging tool to study lymphoedema and associated treatments. Eur J Lymphol Relat Prob, 2011; 22:62\u20132011.","journal-title":"Eur J Lymphol Relat Prob"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e3182268cd9"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2007.01.023"},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.1089\/lrb.2020.0090"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12885-019-6192-1"},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0038-1667362"},{"key":"e_1_3_4_19_2","doi-asserted-by":"publisher","DOI":"10.1002\/jso.24379"},{"key":"e_1_3_4_20_2","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0000000000000599"},{"key":"e_1_3_4_21_2","first-page":"97","article-title":"Lymphoscintigraphic evidence supports the existence of axillo-inguinal anastomotic pathways in a patient with chronic secondary leg lymphoedema subsequent to inguinal node clearance and radiotherapy","volume":"6","author":"Piller N","year":"1997","unstructured":"Piller N, , Goodear M, , Peter D. Lymphoscintigraphic evidence supports the existence of axillo-inguinal anastomotic pathways in a patient with chronic secondary leg lymphoedema subsequent to inguinal node clearance and radiotherapy. Eur J Lymphol Relat Prob, 1997; 6:97\u201399.","journal-title":"Eur J Lymphol Relat Prob"},{"key":"e_1_3_4_22_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm8111917"},{"key":"e_1_3_4_23_2","first-page":"191","article-title":"The role of the lateral upper arm bundle and the lymphatic watersheds in the formation of collateral pathways in lymphedema","volume":"31","author":"Kubik S","year":"1980","unstructured":"Kubik S. The role of the lateral upper arm bundle and the lymphatic watersheds in the formation of collateral pathways in lymphedema. 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