Preoperative Assessment of Lymphatic-Venous Anastomosis Using Indocyanine Green Angiography Combined with Contrast-Enhanced Ultrasound with Perflubutane.

Preoperative Indocyanine Green (ICG) angiography is often used to confirm lymphatic vascular circulation; however, in advanced edema, ICG may be unable to confirm circulation. We use contrast-enhanced ultrasound to confirm the course of lymphatic vessels before lymphaticovenous anastomosis (LVA). We performed ICG angiography and lymphatic contrast-enhanced ultrasound using perflubutane before surgery. The intraoperative detection rate of lymphatic vessels was compared between cases in which only ICG imaging was performed preoperatively and cases in which ICG and contrast-enhanced ultrasound were performed. When comparing the use of ICG alone with the use of ICG in combination with contrast ultrasound, the detection rate of lymphatic vessels in total (72.6% vs 82.8%) and in areas exhibiting a diffuse pattern (54.5% vs 74.0%) was significantly increased. Using this method, we will be able to perform LVA more safely, reliably, and time-efficiently, even in patients with severe lymphedema showing a diffuse pattern on ICG imaging.