Intraoperative imaging of lymphatic vessel using ultra high-frequency ultrasound

Lymphaticovenular anastomosis (LVA) is effective and minimally invasive treatment for refractory lymphedema.1-4 The lymphatic vessels become sclerotic over time after lymph flow obstruction, and lose their function to drain lymph fluid in peripheral lymphedema patient.2 Anastomosing the severely sclerotic lymphatic vessels leads to minimum therapeutic effect in LVA. Therefore, identification of functional lymphatic vessels is important for LVA.3,4 Hayashi et al. reported non-invasive ultrasound visualization of lymphatic vessels in a region masked by dermal backflow pattern of indocyanine green (ICG) lymphography.