Indocyanine green lymphography as novel tool to assess lymphatics in patients with lipedema

Objective: Lipedema is a chronic and progressive disease associated with lymphatic impairment at later stages. The aim of our study was to describe the functional status and anatomy of lower limb superficial lymphatic system using indocyanine green (ICG) lymphography in patients with lipedema. Methods: Following ICG injection at the dorsum of the foot, distance (cm) covered by the dye at 10 (T10 ') and 25 min (T25 ') was measured and normalized for limb length. If the dye did not reach the groin within 25 min, patients were classified as drainage-needing group (DNG). Values of fat and lean distribution assessed by dualenergy X-ray absorptiometry were extracted, and correlation analysis was performed. Furthermore, anatomical patterns of superficial lymphatics were assessed. Results: Overall, 45 women were included, 25 (56%) of whom were classified as DNG. Symptoms duration was significantly associated with DNG status at multivariate analysis (odds ratio 1.07; 95% CI 1.01-1.14; p = 0.047). Moreover, Spearman's analysis showed a negative correlation between symptoms duration and T25 ' dye migration (r = -0.469; p = 0.037). Overall, no major anatomical lymphatic changes were found. Conclusions: Present study suggests that lymphatic functioning in patients with lipedema correlates with symptoms duration. Further research on larger cohorts should verify our findings and clarify their potential therapeutic implications. Overall, ICG lymphography may be promising technique to assess both lymphatic anatomy and functioning in patients with lipedema.

Automated summary

This study used indocyanine green (ICG) lymphography to investigate the functional status and anatomy of the lower limb superficial lymphatic system in patients with lipedema. The results showed a correlation between lymphatic functioning and symptoms duration, and no major anatomical changes were found. ICG lymphography may be a promising technique for evaluating lymphatic anatomy and functioning in lipedema patients.