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Comprehensive Lymphedema Evaluation Using Dynamic ICG Lymphography

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ICG Fluorescence Imaging and Navigation Surgery

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Abstract

Indocyanine green (ICG) lymphography is becoming popular in lymphedema management, since it can visualize superficial lymph flows in real time without radiation exposure. With lymphedema progression, ICG lymphography pattern changes from normal linear pattern to abnormal dermal backflow (DB) patterns (splash, stardust, and diffuse patterns). Splash represents mild DB and reversible change; on the other hand, stardust/diffuse represents moderate/severe DB and irreversible change. DB stages [leg DB (LDB) stage, arm DB (ADB) stage, genital DB (GDB) stage, and facial DB (FDB) stage] allow pathophysiological lymphedema severity staging based on ICG lymphography findings. ICG velocity, lymph pump function, decreases as lymphedema progresses. ICG lymphography is also used as pre- and intraoperative navigation for lymphatic supermicrosurgery such as lymphaticovenular anastomosis. A surgeon can easily find lymphatic vessels in linear pattern. Progression of ICG lymphography pattern represents progression of lymphosclerosis; the more severe DB pattern is detected on ICG lymphography, the more sclerotic lymphatic vessels are. Dynamic ICG lymphography, dual-phase lymphography, allows pathophysiological severity staging, evaluation of lymph transportation capacity, and navigation for lymphatic surgery with one ICG injection. Dynamic ICG lymphography is useful for evaluation of lymphedema prognosis and therapeutic interventions.

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Authors and Affiliations

  1. Department of Plastic and Reconstructive Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Takumi Yamamoto

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  1. Takumi Yamamoto
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Correspondence to Takumi Yamamoto .

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Editors and Affiliations

  1. Department of Surgery, Seiwa Memorial Hospital, Sapporo, Hokkaido, Japan

    Mitsuo Kusano

  2. Hepato-Biliary-Pancreatic Surgery Divisi, University of Tokyo, TOKYO 113-8655, Tokyo, Japan

    Norihiro Kokudo

  3. Department of Breast Surgery Graduate Sc, Kyoto University, Kyoto, Kyoto, Japan

    Masakazu Toi

  4. Department of Surgery, Hirakata Hospital, Kansai Medical University, Hirakata, Osaka, Japan

    Masaki Kaibori

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Yamamoto, T. (2016). Comprehensive Lymphedema Evaluation Using Dynamic ICG Lymphography. In: Kusano, M., Kokudo, N., Toi, M., Kaibori, M. (eds) ICG Fluorescence Imaging and Navigation Surgery. Springer, Tokyo. https://doi.org/10.1007/978-4-431-55528-5_41

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  • DOI: https://doi.org/10.1007/978-4-431-55528-5_41

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  • Publisher Name: Springer, Tokyo

  • Print ISBN: 978-4-431-55527-8

  • Online ISBN: 978-4-431-55528-5

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