Ultrasound imaging of superficially located lymphatic and venous vessels when planning lymphatic drainage operations in cancer patients

Limb lymphedema is a chronic debilitating disease that is one of the main postoperative complications after mastectomy with removal of lymph nodes. Lymphedema can be treated conservatively or surgically, including through tissue resection and direct or indirect lymphatic drainage. Lymphatic-venous anastomosis (LVA) is an effective surgical treatment for obstructive lymphedema that is not amenable to conservative decongestant therapy. This technique was developed on the basis of supermicrosurgery, a technique of applying anastomoses to vessels with a diameter of 0.3—0.8 mm. Objective. Evaluation of the effectiveness and significance of ultrasound examination of lymphatic and venous vessels before the formation of lymphovenous anastomosis. Material and methods. In the period from July 2024 to April 2025 at the P. A. Herzen Moscow Research Institute of Oncology 95 patients were examined after breast cancer treatment. The joint work of the departments of ultrasound diagnostics and oncoplastic surgery included ultrasound examination with marking of superficial veins and lymphatic vessels of the upper limb and lymphography with contrast based on indocyanine (ICG). During the study, the lymphatic and venous vessels of the upper limb were examined from the side of the operation. Results. As a result of the work done, we obtained a 100% match of the performed preoperative markings with the anatomical location of the lymphatic and venous vessels during the operation. Conclusion. Preoperative detection of lymphatic and venous vessels, performed using a high-frequency ultrasound sensor, is fast, economical and allows surgeons to reliably navigate during lymphatic drainage surgery.