“Color Contrast” Technique using 10 % Sodium Fluorescein and Blue Marker to Maximize Visualization During Lymphaticovenous Anastomosis

Summary: Lymphatic vessel wall and lumen visualization during anastomosis is challenging. Different techniques with variable efficacy have been described. Double-opposing color contrast is created using 10% fluorescein sodium, which stains lymphatic fluid yellow, causing a clear contrast to the blue marker–painted lymphatic wall, improving intralumen visualization during the anastomosis process. In this retrospective study, the authors evaluated the success rate of performing anastomosis between the side of the lymphatic vessel and the end of the vein (S-to-E LVA) in 281 patients. The LVA assessment showed mean lymphatic diameter of 0.44 ± 0.09 mm and mean vein diameter of 0.57 ± 0.14 mm with S-to-E success rate of 100% confirmed by postanastomosis indocyanine green lymphography. No adverse events were encountered. Fluorescein sodium was not used in 2 patients because of positive skin allergy test results. This method has the advantages of not needing an additional device, allowing clear visualization, and not staining the surrounding structures. This approach using opposing color contrast between fluorescent yellow and blue marker improved vessel edge identification, which translated into higher visualization and patency with 100% success rate in S-to-E LVA performance.