Comparative effectiveness of 24-MHz high-frequency ultrasound versus ICG for preoperative lymphatic mapping in secondary lower limb lymphedema: A retrospective study.

BACKGROUND

Preoperative lymphatic vessel mapping is essential for lymphaticovenous anastomosis (LVA). This study compared high-frequency ultrasound (HFUS) and indocyanine green (ICG) fluorescent lymphography in preoperative localization for enhancing precision in functional lymphatic vessel identification through ultrasound to provide precise imaging guidance for surgical success.

METHODS

We retrospectively reviewed patients who underwent LVA treatment for unilateral lower limb lymphedema between January 2024 and December 2024. By analyzing their imaging findings, clinical data, and surgical records, we compared the accuracy and efficacy (comparison of preoperative and postoperative volume) of HFUS versus ICG lymphography in preoperative lymphatic vessel mapping for LVA, as well as their impact on operative duration.

RESULTS

One hundred patients with secondary lower limb lymphedema were divided into 2 groups: 50 received HFUS-guided lymphatic mapping (HFUS group), and 50 underwent ICG fluorescent lymphography (ICG group). The HFUS group reported 236 lymphatic vessels, whereas the ICG group reported 183. Localization accuracy was 95.05% for HFUS and 84.73% for ICG (p < 0.001). At 1-week postoperatively, postoperative volume reduction was 7.35 ± 2.09% for HFUS and 5.89 ± 1.59% for ICG (p < 0.001), and mean operative times were 2.00 ± 0.58 h for HFUS and 2.15 ± 0.55 h for ICG (p < 0.001).

CONCLUSION

The HFUS group was more accurate and effective than the ICG group, and could find more functional lymphatic vessels, help reduce the operation time, and improve the operation efficiency.