PMC9970225_01
ICG lymphography showing dermal backflow, stardust pattern and diffuse lymphagiectasia, compatible with Yamamoto stage III/IV lymphedema.
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Lymphatic system evaluation using indocyanine green (ICG) lymphangiography showed Yamamoto stage IV arm dermal backflow (ADB), while hybrid SPECT/CT lymphoscintigraphy, revealed advanced dermal backflow in the left forearm, multiple in-transit lymph nodes in the left upper arm and remaining axillary lymph nodes with decreased function (Figure 1(a)).
1 year post operative ICG showing linear lymphatic vessels and hypoplastic vessels with valve.
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Under microscopic view, three LVAs were performed in an end-to-end anastomosis fashion at the volar ulnar area of the forearm (Figure 2), and immediate restoration of the lymph outflow was confirmed using ICG fluoroscopy.