Superb Microvascular Imaging-Enhanced Lymphatic Ultrasound for Preoperative Mapping in Lymphedema-related Lymphaticovenular Anastomosis.

BACKGROUND

Accurate preoperative identification of functional lymphatic vessels and veins is essential for successful lymphaticovenular anastomosis (LVA). Conventional Doppler-based ultrasonography (D-CUPS [Doppler, cross, uncollapsible, parallel, superficial fascia]) may produce motion-related artifacts that complicate lymphatic-venous discrimination. This study compares examination time and examiner burden between a superb microvascular imaging-based method (S-CUPS) and D-CUPS for preoperative LVA mapping.

METHODS

Twenty patients with primary or secondary lymphedema underwent both D-CUPS and S-CUPS in randomized order before LVA. In 36 limbs, 88 predefined scanning sites were evaluated. Per-site examination time, vessel depth and diameter, intraoperative NECST classification (normal, ectasis, contraction, sclerosis), and examiner fatigue using a 1-10 visual analog scale (VAS) were recorded. Linear mixed-effects models accounted for clustering of multiple sites within patients, and Spearman correlation analyses were performed for continuous variables. All ultrasound-identified veins and lymphatic vessels were confirmed intraoperatively.

RESULTS

S-CUPS shortened per-site examination time compared with D-CUPS (estimated marginal means, 51.7 versus 75.0 s; P = 0.0193). Mental VAS scores were lower with S-CUPS (1.24 ± 0.64 versus 1.86 ± 0.69; P < 0.001), whereas physical VAS scores did not differ significantly (P = 0.19). Larger lymphatic and venous diameters correlated negatively with examination time, and larger lymphatic diameter was associated with lower physical fatigue. BMI correlated positively with lymphatic depth but not with examination time or VAS scores. Ectasis-type lymphatic vessels predominated intraoperatively (79.5%).

CONCLUSIONS

S-CUPS was associated with shorter per-site examination time and lower examiner-reported mental fatigue than D-CUPS in preoperative mapping for lymphedema-related LVA, although the modest magnitude of these differences warrants further validation in clinical practice.