The Influence of Multipoint Indocyanine Green Injections on the Outcome of LVA Surgery in Patients with Lower Limb Lymphedema

Abstract

Background: This article aims to investigate the benefit of multipoint indocyanine green (ICG) injection for fluorescent lymphography during lymphatic venous anastomosis (LVA).

Methods: The research included 56 patients with unilateral lower extremity lymphedema who underwent LVA between December 2021 and April 2024. Two groups were analyzed: in group 1, 24 patients received single-point ICG injections, with ICG injected in the first webbing space of each foot, and in group 2, 32 patients received multipoint ICG injections, with additional ICG injections in the anterior of the medial and lateral malleolus and knee joints. The operative duration and lower extremity lymphedema index (LELI) were recorded.

Results: Patients in group 2 had a shorter operative time (5.01 ± 0.58 hr) compared to patients in group 1 (5.62 ± 0.89 hr) (P = 0.024). The mean ΔLELI was 24.72 ± 21.15 in group 1 and 35.82 ± 19.11 in group 2 (P = 0.041). The average number of incisions in the injured limb was 4.83 ± 0.58 and 5.22 ± 0.53 for group 1 and group 2, respectively (P = 0.098). The mean number of lymphatic vessels in the injured limb was 4.29 ± 0.93 in group 1 and 5.09 ± 0.83 in group 2 (P = 0.002). The average number of lymphaticovenular anastomoses performed in the injured limb was 4.21 ± 0.67 in group 1 and 5.06 ± 0.85 in group 2 (P = 0.001).

Conclusion: This research demonstrates that multipoint injection of ICG enhances identification of functional lymphatics, increases the number of lymphatic anastomoses performed in the injured limb, reduces operative time, and greatly improves the circumference of the affected limbs after LVA surgery.