Superb Microvascular Imaging-Enhanced Lymphatic Ultrasound for Preoperative Mapping in Lymphedema-related Lymphaticovenular Anastomosis.

Background: Accurate preoperative identification of functional lymphatic vessels and veins is essential for successful lymphaticovenular anastomosis (LVA). Conventional Doppler-based ultrasonography (D-CUPS [Doppler, cross, uncollapsible, parallel, superficial fascia]) may produce motion-related artifacts that complicate lymphatic-venous discrimination. This study compares examination time and examiner burden between a superb microvascular imaging-based method (S-CUPS) and D-CUPS for preoperative LVA mapping. Methods: Twenty patients with primary or secondary lymphedema underwent both D-CUPS and S-CUPS in randomized order before LVA. In 36 limbs, 88 predefined scanning sites were evaluated. Per-site examination time, vessel depth and diameter, intraoperative NECST classification (normal, ectasis, contraction, sclerosis), and examiner fatigue using a 1-10 visual analog scale (VAS) were recorded. Linear mixed-effects models accounted for clustering of multiple sites within patients, and Spearman correlation analyses were performed for continuous variables. All ultrasound-identified veins and lymphatic vessels were confirmed intraoperatively. Results: S-CUPS shortened per-site examination time compared with D-CUPS (estimated marginal means, 51.7 versus 75.0 s; Conclusions: S-CUPS was associated with shorter per-site examination time and lower examiner-reported mental fatigue than D-CUPS in preoperative mapping for lymphedema-related LVA, although the modest magnitude of these differences warrants further validation in clinical practice.