Lymphatic Mapping Using US Microbubbles before Lymphaticovenous Anastomosis Surgery for Lymphedema

Area of Science:

• Vascular Surgery
• Medical Imaging
• Lymphedema Management

Background:

• Secondary lymphedema of the extremities is often treated with lymphaticovenous anastomosis (LVA) surgery.
• Indocyanine green (ICG) fluorescent lymphography is the standard for identifying target lymphatic vessels but has limitations.
• Improved preoperative planning methods are needed for LVA surgery.

Purpose of the Study:

• To assess the utility of contrast-enhanced ultrasound (CEUS) in identifying target lymphatic vessels for LVA surgery in patients with secondary upper extremity lymphedema.
• To compare CEUS findings with indocyanine green (ICG) fluorescent lymphography.

Main Methods:

• A retrospective review of 11 patients with secondary upper extremity lymphedema who underwent CEUS before LVA surgery.
• CEUS involved intradermal injection of microbubbles to visualize lymphatic vessels.
• Technical success was defined as CEUS-identified lymphatic vessels leading to successful LVA.

Main Results:

• CEUS successfully identified lymphatic vessels in all 11 patients.
• ICG lymphography was not performed or failed in six patients.
• CEUS-guided LVA had a technical success rate of 67% (22 of 33 explorations).
• CEUS enabled additional LVAs in seven patients where ICG failed.

Conclusions:

• Contrast-enhanced ultrasound (CEUS) is a promising tool for preoperative planning in LVA surgery for upper extremity lymphedema.
• CEUS is particularly valuable when indocyanine green (ICG) fluorescent lymphography is not feasible or fails to identify target vessels.