Restricted accessResearch articleFirst published online 2025-9
Application of preoperative ultrasound combined with indocyanine green lymphography in lymphaticovenular anastomosis of the lower limb-A retrospective study research
We evaluated the application of preoperative ultrasound (US) combined with indocyanine green (ICG) lymphography in lymphaticovenular anastomosis (LVA) of the lower limb.
Methods
66 patients with lower limb lymphedema were selected as study subjects and divided into research (n = 35) and control groups (n = 31). The patients were treated with LVA using ICG lymphography combined with US and simple ICG lymphography as the positioning method. The number of lymphatic vessels anastomosed, diameter, depth, and searching time were compared.
Results
The number of anastomotic lymphatic vessels in the research group was more than in the control group (p < .05). Compared with the lymphatic vessels under ICG lymphography, the lymphatic vessels under US locating had less search time, larger diameter, and deeper depth (p < .05).
Conclusion
US combined with ICG lymphography in preoperative can increase the number of lymphatic vessels and shorten the time to find lymphatic vessels.
MohosBCzedik-EysenbergMSteinbacherJ, et al.Long-term Use of ultrasound for locating optimal LVA sites: a descriptive data analysis. J Reconstr Microsurg2022; 38(3): 238–244.
2.
TogawaKMaHSmithAW, et al.Self-reported symptoms of arm lymphedema and health-related quality of life among female breast cancer survivors. Sci Rep2021; 11(1): 10701.
3.
AhmedRLPrizmentALazovichD, et al.Lymphedema and quality of life in breast cancer survivors: the Iowa Women's Health Study. J Clin Oncol2008; 26(35): 5689–5696.
4.
ŞahinoğluEErginGKaradibakD. The efficacy of change in limb volume on functional mobility, health-related quality of life, social appearance anxiety, and depression in patients with lower extremity lymphedema. Phlebology2022; 37(3): 200–205.
5.
DessourcesKAvikiELeitaoMMJr. Lower extremity lymphedema in patients with gynecologic malignancies. Int J Gynecol Cancer2020; 30(2): 252–260.
6.
KerchnerKFleischerAYosipovitchG. Lower extremity lymphedema update: pathophysiology, diagnosis, and treatment guidelines. J Am Acad Dermatol2008; 59(2): 324–331.
7.
ClinckaertACallensKCooremanA, et al.The Prevalence of lower limb and genital lymphedema after prostate cancer treatment: a systematic review. Cancers2022; 14(22): 5667.
8.
KurodaKYamamotoYYanagisawaM, et al.Risk factors and a prediction model for lower limb lymphedema following lymphadenectomy in gynecologic cancer: a hospital-based retrospective cohort study. BMC Womens Health2017; 17(1): 50.
9.
ZhouXLiuBGuoX, et al.Application of indocyanine green lymphography combined with methylene blue staining in lymphaticovenular anastomosis of lower limb vessels: a prospective study. Phlebology2023; 38(7): 466–473.
10.
ZhouXMaGQiX, et al.Application of complete decongestive therapy after lymphaticovenular anastomosis of the lower limb combined with liposuction-A retrospective study research. Phlebology2024; 39(1): 49–57.
11.
Executive Committee of the International Society of Lymphology. The diagnosis and treatment of peripheral lymphedema: 2020 Consensus Document of the International Society of Lymphology. Lymphology2020; 53(1): 3–19.
12.
KarlssonTMackieHKoelmeyerL, et al.Liposuction for advanced lymphedema in a Multidisciplinary Team Setting in Australia: 5-year follow-up. Plast Reconstr Surg2024; 153(2): 482–491.
13.
KoshimaIInagawaKUrushibaraK, et al.Supermicrosurgical lymphaticovenular anastomosis for the treatment of lymphedema in the upper extremities. J Reconstr Microsurg2000; 16(6): 437–442.
14.
YamamotoTYamamotoN. Office-based lymphatic supermicrosurgery: Supermicrosurgical lymphaticovenular anastomosis at an Outpatient clinic. J Reconstr Microsurg2023; 39(2): 131–137.
15.
ChenWFTuncerFBZengW. Advanced technical Pearls for successful Supermicrosurgical lymphaticovenular anastomosis. Ann Plast Surg2021; 86(3S Suppl 2): S165–S172.
16.
ShimboKKawamotoHKoshimaI. Conservative treatment versus lymphaticovenular anastomosis for early-stage lower extremity lymphedema. J Vasc Surg Venous Lymphat Disord2023; 11(6): 1231–1240.
17.
NagaseTGondaKInoueK, et al.Treatment of lymphedema with lymphaticovenular anastomoses. Int J Clin Oncol2005; 10: 304–310.
18.
LiuHLPangSYChanYW. The use of a microscope with near-infrared imaging function in indocyanine green lymphography and lymphaticovenous anastomosis. J Plast Reconstr Aesthet Surg2014; 67(2): 231–236.
19.
LauritzenEBredgaardRLaustsen-KielCM, et al.Indocyanine green angiography in oncoplastic breast surgery, a prospective study. J Plast Reconstr Aesthet Surg2023; 85: 276–286.
20.
Moreno LlorentePGarcía BarrasaAFrancos MartínezJM, et al.Intraoperative indocyanine green angiography of Parathyroid Glands and the prevention of post-Thyroidectomy Hypocalcemia. World J Surg2022; 46(1): 121–127.
21.
VenkateshRReddyNGPrabhuV, et al.Indocyanine green angiography imaging findings in artery occlusions. Eur J Ophthalmol2022; 32(4): 2395–2403.
22.
HayashiAHayashiNYoshimatsuH, et al.Effective and efficient lymphaticovenular anastomosis using preoperative ultrasound detection technique of lymphatic vessels in lower extremity lymphedema. J Surg Oncol2018; 117(2): 290–298.
23.
OgataFNarushimaMMiharaM, et al.Intraoperative lymphography using indocyanine green dye for near-infrared fluorescence labeling in lymphedema. Ann Plast Surg2007; 59: 180–184.
24.
Czedik-EysenbergMSteinbacherJObermayerB, et al.Exclusive use of ultrasound for locating optimal LVA sites-A descriptive data analysis. J Surg Oncol2020; 121(1): 51–56.
25.
ViscontiGYamamotoTHayashiN, et al.Ultrasound-assisted lymphaticovenular anastomosis for the treatment of peripheral lymphedema. Plast Reconstr Surg2017; 139(6): 1380e–1381e.
26.
YamamotoTMatsudaNTodokoroT, et al.Lower extremity lymphedema index: a simple method for severity evaluation of lower extremity lymphedema. Ann Plast Surg2011; 67(6): 637–640.
27.
DevoogdtNDe GroefAHendrickxA, et al.Lymphoedema functioning, disability and health questionnaire for lower limb lymphoedema (lymph-ICF-LL): reliability and validity. Phys Ther2014; 94(5): 705–721.
28.
WangCMLeeSYHsuKF, et al.Psychometric evaluation of a Chinese version of lymphoedema functioning, disability and health questionnaire for lower limb lymphoedema in women with gynaecological cancer surgery. Eur J Cancer Care2018; 27(6): e12940.
29.
YamamotoTYamamotoNYoshimatsuH, et al.Factors Associated with Lymphosclerosis: an analysis on 962 lymphatic vessels. Plast Reconstr Surg2017; 140(4): 734–741.
30.
YamadaY. Studies on lymphatic venous anastomosis in lymphedema. Nagoya J Med Sci1969; 32: 1–21.
31.
O’BrienBMSykesPThrelfallGN, et al.Microlymphaticovenous anastomoses for obstructive lymphedema. Plast Reconstr Surg1977; 60(2): 197–211.
MasiàJPonsGRodríguez-BauzàE. Barcelona lymphedema algorithm for surgical treatment in breast cancer-related lymphedema. J Reconstr Microsurg2016; 32: 329–335.
34.
YamamotoTYamamotoNNarushimaM, et al.Lymphaticovenular anastomosis with guidance of ICG lymphography. J Jpn Coll Angiol2012; 52: 327–331.
35.
YamamotoTKoshimaI. Subclinical lymphedema: Understanding is the clue to decision making. Plast Reconstr Surg2013; 132: 472e–473e.
36.
ChengMHChenSCHenrySL, et al.Vascularized groin lymph node flap transfer for postmastectomy upper limb lymphedema: flap anatomy, recipient sites, and outcomes. Plast Reconstr Surg2013; 131: 1286–1298.
37.
TzaniITsichlakiMZervaE, et al.Physiotherapeutic rehabilitation of lymphedema: state‐of‐the‐art. Lymphology2018; 51(1): 1–12.
38.
MiharaMHaraHTangeS, et al.Multisite lymphaticovenular bypass using supermicrosurgery technique for lymphedema management in lower lymphedema cases. Plast Reconstr Surg2016; 138(1): 262–272.
39.
MiharaMHaraHKawakamiY. Ultrasonography for classifying lymphatic sclerosis types and deciding optimal sites for lymphatic-venous anastomosis in patients with lymphoedema. J Plast Reconstr Aesthet Surg2018; 71(9): 1274–1281.
