Percutaneous Lymphatic Contrast-enhanced Ultrasound for Preoperative Localization in Stage 2-3 Lymphedema: A...

Lymphaticovenous anastomosis (LVA) is a crucial surgical method for treating lymphedema by reconstructing lymphatic pathways. The success and efficacy of LVA rely on accurate preoperative localization of functional lymphatic vessels. This study investigated the use of percutaneous lymphatic contrast-enhanced ultrasound (PL-CEUS) to identify and localize these vessels in patients with the International Society of Lymphology stages 2-3 before LVA.

This retrospective cohort study included 234 patients with 256 limbs affected by International Society of Lymphology stage 2-3 lymphedema. Preoperatively, a contrast agent was injected intradermally, and functional lymphatic vessels were dynamically visualized and localized by ultrasound. Using surgical findings as the gold standard, the localization accuracy of PL-CEUS was calculated. The diameter and depth of the lymphatic vessels from the body surface were analyzed. Short-term postoperative efficacy was evaluated by comparing changes in limb circumference within 1 week postoperatively.

PL-CEUS visualized lymphatic vessels in 218 of 256 limbs (85.2%), identifying 468 vessels. The mean inner diameters were 0.52 ± 0.26 mm (stage 2) and 0.59 ± 0.35 mm (stage 3), with mean depths of 8.61 ± 3.40 and 11.03 ± 4.38 mm, respectively. Surgical verification showed localization accuracies of 96.04% (stage 2) and 93.64% (stage 3). Postoperative limb circumference measurements within 1 week revealed a significant reduction, with a mean reduction rate of 3.73% ± 3.55%.

PL-CEUS accurately localizes superficial functional lymphatic vessels and may serve as an alternative or complementary method to indocyanine green lymphography for preoperative lymphatic mapping in LVA.