Near-Infrared Fluorescent Lymphography Using ICG

Near-infrared fluorescent lymphography using indocyanine green (ICG) is becoming popular as ICG lymphography for lymphedema evaluation. ICG lymphography clearly can visualize superficial lymph flows in real time, which has the highest sensitivity and specificity to detect abnormal lymph circulation. Dynamic ICG lymphography, dual-phase observation (at an early transient phase and a late plateau phase), is critical to maximize efficacy of ICG lymphography. Linear pattern is evaluated at an early phase, and dermal backflow differentiation and extension are evaluated at a late phase. Dynamic ICG lymphography allows early diagnosis of lymphedema, pathophysiological severity evaluation of lymphedema, and prediction of lymph vessel conditions and prognosis. ICG lymphography stage is useful to classify pathophysiological severity of secondary lymphedema and to consider indication of lymphedema treatments based on natural course and prognostic outcomes after each therapeutic intervention. Lymphographic findings are to optimize efficacy of manual lymph drainage. Intraoperative ICG lymphography navigates a surgeon to dissect the lymph vessel and allows precise evaluation of lymphaticovenous anastomosis (LVA) quality, especially regarding minor leakage of the lymph. Postoperative ICG lymphography is used to evaluate postoperative patency of lymphaticovenous anastomosis and pathophysiological conditions of lymphedema. ICG lymphography plays an essential role in lymphedema management, including conservative and surgical interventions.