Preoperative planning of venturi-like lymphaticovenous anastomosis for secondary lower extremity lymphedema using contrast-enhanced ultrasound

Venturi-like lymphaticovenous anastomosis (LVA), which utilizes venular branches as recipient veins, is hypothesized to be beneficial for maintaining postoperative anastomotic patency. This study assessed the impact of preoperative contrast-enhanced ultrasound lymphography (CEUS-L) on the preoperative localization and intraoperative efficiency of Venturi-like LVA in lower extremity lymphedema following gynecologic cancer treatment. Patients who underwent Venturi-like LVA (November 2021 to August 2023) for lower extremity lymphedema post-gynecologic cancer treatment were enrolled in this retrospective cohort study. The study and control groups were divided based on whether preoperative CEUS-L was implemented. Difference analysis was conducted to compare LVA-related indicators between groups and dermal backflow (DBF) patterns across various clinical stages. True positive rate (the ratio of successful anastomoses to preoperative marking-guided surgical incisions) of CEUS-L was calculated. Twenty-nine women were studied, including 21 in study group (mean age: 61 years ± 10 [SD]) and 8 in control group (mean age: 59 years ± 6 [SD]). The study group exhibited higher successful anastomoses (median: 8 vs. 3, P < 0.001) and shorter average anastomosis time (median: 55 vs. 97.5 min, P < 0.001) compared to the control group. The detection rate of DBF increased with lymphedema clinical stage (stage I, II and III: 0%, 62.5% and 90.9%, respectively), reaching statistical significance between stages I and III ( P < 0.05, Bonferroni-adjusted). The true positive rate of CEUS-L was 90.2% (156 of 173 incisions). The utilization of CEUS-L combined with HFCDU may improve preoperative localization and intraoperative efficiency for Venturi-like LVA, while larger prospective studies with long-term follow-up are required.