Successful treatment of early‐stage lower extremity lymphedema with side‐to‐end lymphovenous anastomosis with indocyanine green lymphography assisted

PURPOSE: This study was to investigate intraoperative assessment of side-to-end lymphovenous anastomosis (LVA) with indocyanine green (ICG) and the correlation between its patency and surgical outcome. METHODS: LVA was applied to five patients with early-stage lower extremity lymphedema. Side-to-end anastomosis and then end-to-end anastomosis were created as a second alternative. Immediately after the anastomosis, ICG was used to confirm its patency. RESULTS: The mean number of anastomoses was 2.0 ± 0.7, and the types of anastomoses were primarily side-to-end and secondarily end-to-end. The mean reduction rate was 63.8 ± 20.2% after LVA at 10 ± 6.4 months of follow-up. In all cases, the affected extremities became soft immediately after surgery, and no cellulitis episodes were observed. CONCLUSION: Side-to-end LVA can be an effective treatment for early-stage lower extremity lymphedema. ICG lymphodynamic assessment is useful not only in the preoperative identification of functional lymphatics but also in the intraoperative visualization of new drainage routes in LVA surgery.