Indocyanine green lymphangiography for the management of lymphatic complications after vascular surgery

Abstract

Objectives: Lymphatic complications after vascular surgery are frequent, but their optimal management is still controversially discussed. Early surgical intervention with ligation of the leaking vessels seems to reduce recurrence rates and improve outcomes. The use of indocyanine green (ICG) fluorescence imaging can help identify leaking vessels, but its value in vascular procedures is still underreported. Methods: Between January 2020 and December 2021, ICG lymphangiography was used in three patients who presented persistent lymphatic drainage after vascular procedures in the groin. Verdye ® ICG was injected at the anterior, medial, and lateral aspects of the thigh and the wound examined with an infrared laparoscopy camera. Leaking lymphatics were identified and oversewn or closed by a vessel-sealing device. Results: All patients were initially managed with wound debridement and negative pressure wound therapy to quantify the amount of the lymphatic leak. ICG-lymphangiography was performed when daily leakage of the lymph exceeded 50cc over a period of 4 days. In two patients, the leaking vessels were successfully identified and closed with complete resolution of symptoms. Due to persistent leakage, the third patient underwent a second ICG lymphangiography. At the two-month follow-up, patients showed no recurrence. Conclusions: Surgical therapy with ligation of lymphatic vessels is an effective method to stop lymphatic leakage and prevent further complications. ICG lymphangiography enables quick and accurate identification of the leaking vessels.