ICG Lymphography for Lymphedema

ICG lymphography is a minimally invasive imaging method that visualizes lymphatic flow in real time. At Lymphedema Clinic Tokyo, we use advanced techniques including multi-lymphosome ICG lymphography and multimodal evaluation to assess lymphatic function accurately. This page explains how ICG lymphography helps international patients understand their condition and explore appropriate treatment options with confidence.

ICG lymphography for lower limb lymphedema

ICG lymphography for upper limb lymphedema

Indocyanine Green (ICG) Lymphography at Lymphedema Clinic Tokyo

— Visualizing Lymphatic Flow to Guide Personalized Care —

Lymphedema often begins before visible swelling becomes obvious.

In many patients, subtle changes in lymphatic flow occur first, causing heaviness, tightness, discomfort, or anxiety long before conventional tests show clear abnormalities.

At Lymphedema Clinic Tokyo, we use ICG lymphography as a key tool to understand these early and hidden changes—so that treatment decisions are based not only on appearance or disease duration, but on how your lymphatic system is actually functioning today.

【What Is ICG Lymphography?】

ICG lymphography is a minimally invasive imaging examination in which a very small amount of indocyanine green dye is injected into the skin. Using near-infrared imaging, we can observe lymphatic flow in real time just beneath the skin.

This examination allows us to evaluate:

The direction and speed of lymphatic flow

Areas of stagnation or reflux (dermal backflow)

Whether functional lymphatic vessels are still present

Rather than focusing only on limb size, ICG lymphography helps us understand the functional condition of the lymphatic system itself.

【Why We Place Special Emphasis on ICG Lymphography】

Multiple clinical studies have shown that:

Early-stage lymphedema may not always be detected by conventional imaging alone

Functional lymphatic abnormalities can exist even when swelling is mild or intermittent

In some advanced cases, functional lymphatic vessels may still remain

ICG lymphography has been shown to be particularly helpful in detecting these functional changes, supporting both early diagnosis and precise surgical planning when appropriate.

At our clinic, ICG lymphography is not used in isolation.

We believe that no single test can fully explain lymphedema.

【Our Multimodal, Stepwise Evaluation Approach】

At Lymphedema Clinic Tokyo, our diagnostic strategy is designed to be both comprehensive and patient-centered.

1．First, we perform lymphoscintigraphy to evaluate overall lymphatic flow, including deep lymphatic pathways and systemic drainage.

This helps us understand the broader disease pattern and determine the general treatment direction.

2．When surgical treatment such as lymphaticovenular anastomosis (LVA) is considered, we perform:

ICG lymphography

Lymphatic ultrasound

These examinations are typically carried out on the day of surgery to allow precise, site-specific planning—helping us decide which lymphatic vessels and veins should be connected, and where.

3．If ICG lymphography cannot be performed, for example due to contrast allergy, we rely on careful lymphoscintigraphy and detailed lymphatic ultrasound to ensure safe and accurate identification of lymphatic vessels.

This multimodal approach is supported by clinical research and allows us to tailor care to each individual patient.

【For Patients With Long-Standing or Advanced Lymphedema】

Some patients are told that their lymphedema is “too advanced” for further treatment options.

Recent research, however, suggests that advanced stage does not always mean that all functional lymphatic vessels are lost.

By carefully evaluating lymphatic function using modern imaging techniques, it may still be possible to identify meaningful treatment options—even in cases previously thought to be unsuitable for surgery.

Our goal is not to promise outcomes, but to help you understand your current condition accurately and explore realistic options with clarity and honesty.

【What This Examination Can Offer You】

ICG lymphography does not automatically lead to surgery.

Instead, it provides:

A clearer understanding of your lymphatic condition

A rational basis for continuing conservative therapy, surgical consideration, or observation

Confidence in making informed decisions about your care

Many patients tell us that simply understanding what is happening inside their body brings relief and reassurance.

【For International Patients Considering Consultation】

Lymphedema is not a condition you should face alone.

At Lymphedema Clinic Tokyo, we offer:

Careful review of prior medical records and imaging

Clear explanations in understandable language

Individualized treatment planning based on objective evaluation

If you are unsure whether to proceed, that uncertainty itself is a valid reason to seek expert advice.

We welcome international patients who wish to better understand their condition and explore their options in a thoughtful, supportive environment.

【Editorial Responsibility】

Makoto Mihara, Yohei Iwanaga

【Frequently Asked Questions (FAQ)】

Q1. What is ICG lymphography, and why is it important in lymphedema care?

ICG lymphography is a minimally invasive imaging examination that allows us to visualize lymphatic flow in real time just beneath the skin.

A very small amount of indocyanine green (ICG) dye is injected into the skin, and near-infrared imaging is used to observe how lymph flows through the lymphatic vessels. This enables us to evaluate lymphatic function, not just limb size or appearance.

For many patients, lymphatic dysfunction begins before visible swelling becomes obvious, which is why functional evaluation is so important.

Q2. Can ICG lymphography detect early-stage lymphedema?

Yes. Clinical research has shown that early-stage lymphedema may not always be detected by conventional imaging alone, especially when swelling is mild or fluctuates.

ICG lymphography is particularly useful for identifying:

Early lymphatic flow disturbance

Dermal backflow (lymphatic reflux)

Subtle functional abnormalities

This makes it a valuable tool for early diagnosis and informed decision-making.

Q3. Is ICG lymphography useful in advanced-stage lymphedema?

In some cases, yes.

Recent studies suggest that even in advanced-stage lymphedema, functional lymphatic vessels may still remain. Using detailed imaging techniques—such as ICG lymphography combined with lymphatic ultrasound—it may be possible to identify these remaining pathways.

However, this does not mean that surgery is appropriate for everyone. Each case must be evaluated individually.

Q4. Does Lymphedema Clinic Tokyo rely only on ICG lymphography?

No. At Lymphedema Clinic Tokyo, we believe that no single test is sufficient to fully understand lymphedema.

Our approach is multimodal:

Lymphoscintigraphy is performed first to assess overall and deep lymphatic flow throughout the body.

ICG lymphography is used to evaluate superficial lymphatic function in detail.

Lymphatic ultrasound helps identify the condition and location of lymphatic vessels and nearby veins.

By combining these methods, we can form a more complete and accurate picture of each patient’s condition.

Q5. When is ICG lymphography performed at your clinic?

If surgical treatment such as lymphaticovenular anastomosis (LVA) is being considered, ICG lymphography and lymphatic ultrasound are typically performed on the day of surgery.

This allows us to:

Identify functional lymphatic vessels

Select appropriate veins

Plan the most suitable anastomosis for each specific area

This real-time evaluation supports precise and individualized surgical planning.

Q6. What if I cannot undergo ICG lymphography due to contrast allergy?

ICG lymphography cannot be performed in patients with certain contrast allergies.

In such cases, we carefully rely on:

Detailed lymphoscintigraphy

Meticulous lymphatic ultrasound

Using these examinations, we can still identify lymphatic vessels and veins accurately and safely when planning treatment, including surgery when appropriate.

Q7. Does undergoing ICG lymphography mean that surgery will be recommended?

No. ICG lymphography is not a test performed solely to decide on surgery.

Its purpose is to provide objective information about your current lymphatic function. Based on the results, possible next steps may include:

Continuing or optimizing conservative therapy

Monitoring over time

Considering surgical options, if appropriate

All decisions are made together with the patient, based on both medical findings and personal goals.

Q8. I live overseas. Can I still consult your clinic?

Yes. Many of our patients travel from outside Japan.

We offer:

Careful review of medical records and imaging obtained abroad

Clear explanations in understandable English

Individualized evaluation and treatment planning

Our aim is to help international patients gain clarity and confidence, regardless of where their previous care was provided.

【Our Message】

If you are reading this page, you may be feeling uncertain—about your diagnosis, your test results, or what steps to take next.

That uncertainty is completely understandable.

Lymphedema is not defined only by visible swelling or disease duration.

What matters most is how your lymphatic system is functioning right now.

At Lymphedema Clinic Tokyo, we believe that every patient deserves:

A careful and respectful evaluation

Clear, honest explanations

Thoughtful consideration of all reasonable options

Whether your condition is early, advanced, or somewhere in between, understanding your current state can bring reassurance and direction.

If you wish to better understand your lymphedema and explore your options in a supportive, evidence-based environment, we welcome you to consult with us.

【Editorial Responsibility】　Makoto Mihara, Yohei Iwanaga