Evaluation of custom-made Indocyanine green lymphography system for preoperative planning of lymphovenous anastomosis in secondary lymphedema patients

Background: lymphedema is a chronic and progressive disease that can result from the loss of lymphatic pathways or from congenital lymphatic malformations. When treating lymphedema, complete decongestive therapy is the initial line of treatment. Lymphatic surgery steps in when conservative treatment fails. ICG lymphography is a precise, and sensitive technique that is frequently utilized in lymphatic imaging for lymphovenous anastomosis preoperative planning. Many fluorescence imaging systems for lymphatic vessel mapping have been developed in past decades.Objective: This study will evaluate the feasibility of a custom-made indocyanine green fluorescence lymphography system for preoperative identification of the lymphatic vessels in cases of secondary lymphedema.Patients and Methods: A small-scale clinical trial to assess the feasibility of a custom made ICG lymphography system for preoperative mapping of lymphatic vessels on 10 patients who underwent lymphoveonus anastomosis at Ain Shams University hospitals between May 2022 and May 2023.Results: Ten Patients with secondary lymphedema underwent preoperative mapping of lymphatic vessels using custom-made ICG lymphography system, then lymphovenous anastomoses were done for all cases. Four to seven linear lymph vessels were visualized in each case with mean 5.11 ± 1.27 SD. Two lymphovenous anastomoses were done in 6 cases, three LVA were done in 3 cases while 1 LVA was done one patient. The patients were followed up for 6 months after the operation, Seven cases were improved, however 3 cases showed no improvement. Improvement was measured by gradual decrease in limb circumference in comparison to measurements before the operation.Conclusion: This study showed that the custom made lymphography system, with affordable price is a feasible for visualizing the lymphatic vessels prior to lymphovenous anastomosis. LVA has been proved to be a good method of treatment of chronic leg ulcers.