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. 2025 Jun 12.
doi: 10.1097/MAT.0000000000002478. Online ahead of print.

Fluorescent Imaging-Guided Ligation of Lymphatic Leaks Following Decannulation From Extracorporeal Membrane Oxygenation

Hamzah Almadani  1 , Youssef Aref  1 , Zachary Brennan  2 , Andrew Cantor  1 , Tyler Gunn  2 , Philip S Brazio  1
Affiliations

Fluorescent Imaging-Guided Ligation of Lymphatic Leaks Following Decannulation From Extracorporeal Membrane Oxygenation

Hamzah Almadani et al. ASAIO J. .

Abstract

Lymphocele is a known complication of veno-arterial extracorporeal membrane oxygenation (VA-ECMO). We present a novel application of fluorescent lymphatic imaging for the highly selective treatment of lymphatic leaks after VA-ECMO and describe patient outcomes at our institution. A retrospective review of patients who underwent lymphatic ligation following VA-ECMO from 2022 to 2024 was performed. Fluorescent imaging and intradermal indocyanine green injection were used to identify and ligate lymphatic leaks within the debrided wound bed. Ten patients with a mean age of 48.3 years were included. The mean number of lymphatics ligated was 5. Mean days from decannulation to ligation and from ligation to drain removal were 18.4 and 22.2, respectively. There was a significant decrease in drain output immediately following ligation (197.4 ml/day vs. 64.2 ml/day; p = 0.016). A shorter time from decannulation to ligation was significantly correlated with a decrease in drain output. A higher drain fluid lymphocyte percentage was significantly correlated with a shorter time to drain removal. Fluorescent imaging-guided lymphatic ligation is an effective method for treating lymphatic leak after decannulation from VA-ECMO. Drain fluid analysis and early consultation with plastic surgery should be encouraged in the event of high-output lymphocele.

Keywords: ECMO; ICG; indocyanine green; ligation; lymphocele.

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Conflict of interest statement

Disclosure: The authors have no conflicts of interest to report.

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