Preliminary study on the application of contrast-enhanced ultrasound in lymphovenous anastomosis

To explore the value of lymphatic contrast-enhanced ultrasound (CEUS) in lymphovenous anastomosis (LVA), with a particular focus on its role in preoperative lymphatic localization.

On the basis of whether preoperative ultrasound lymphatic contrast imaging was performed, the lymphatic diameter and depth from the skin were measured. Patients were divided into two groups: indocyanine green (ICG, 21 patients) and ICG combined with CEUS (21 patients). The differences between the two groups were compared in terms of total surgery time; number of anastomoses; anastomosis time per lymphatic vessel; and limb volume reduction at 1 week, 1 month, and 3 months postoperatively. A P value of < .05 was considered to indicate statistical significance.

In the ICG + CEUS group, the success rate of ultrasound contrast imaging was 95%. The average lymphatic diameter was 0.6 ± 0.2 mm, and the average depth from the skin was 5.3 ± 2.8 mm. Among these patients, 74% had lymphatic reflux, 55% had reflux into the dermis, and 36% had collateral vessel formation. Compared with the ICG group, the ICG + CEUS group had a significantly shorter total surgery time (320 ± 124 vs 398 ± 93 minutes; P = .005), shorter anastomosis time per lymphatic vessel (14 ± 2 vs 32 ± 15 minutes; P < .001), and more anastomoses (median 19 vs 12; P < .001). There were no significant differences between the two groups in terms of limb volume reduction at 1 week, 1 month, or 3 months postoperatively (P > .05).

CEUS can be a powerful supplement for locating lymphatic vessels before LVA.