Lymphatic ultrasound (D-CUPS) and multi-point ICG lymphography for successful LVA

Abstract

Securing dilated lymphatic vessels with good function is challenging when performing lymphaticovenous anastomosis (LVA). To achieve this, we propose multi-point indocyanine green (ICG) lymphography and lymphatic ultrasound (D-CUPS; Doppler, Cross, Uncollapsible, Parallel, and Superficial fascia). With multi-point ICG lymphography, more lymphatic vessels can be found than with conventional ICG lymphography, which leads to better surgical results. Lymphatic ultrasound is more useful because it allows the observation of cross-sections of lymphatic vessels. It is known that lymphatic degeneration occurs in the lymphatic vessels in lymphedematous limbs, and LVA is most effective when dilated lymphatic vessels are anastomosed. The degree of lymphatic degeneration can be diagnosed with lymphatic ultrasound, and the proximity of dilated lymphatic vessels and veins suitable for anastomosis can be reliably identified and selected as the skin incision site for LVA. Lymphatic ultrasound is a safe, versatile and useful imaging technique that does not require a contrast agent and can be performed by anyone. By mastering multi-point ICG lymphography and lymphatic ultrasound (D-CUPS), the operation time can be shortened, and more effective LVA can be performed. In this Technical Note article, we comprehensively describe lymphatic function examinations that we have developed so far.