The Oxford Lymphoedema Practice: ICG Lymphography

The Oxford Lymphoedema Practice: ICG Lymphography

I recently attended an initial consultation at the Oxford Lymphoedema Practice with Professor Furniss which also included an ICG scan. My aim going into this appointment was to deepen my understanding of my condition, specifically identifying where the lymphatic defect lies in my leg and to explore possible surgical options tailored to my case.

The appointment began with a questionnaire assessing the impact of lymphoedema on my life. The questions covered a wide range, from the physical and emotional toll, to how it influences social interactions and my overall lifestyle. We then had an in-depth discussion about the different types of primary lymphoedema and the surgical treatments available for each one. Importantly, we explored how lymphoedema intersects with my career in dance and the psychological challenges of working in a highly image-focused industry. The compassion and understanding shown by every member of staff at the clinic made what could have been a daunting experience feel welcoming and safe.

Following the consultation, I underwent the indocyanine green lymphography (ICG scan). First, a local anaesthetic was administered to the tops of both feet, just below the big toes, followed by the injection of a green infrared dye. The procedure was surprisingly painless. Afterward, I was asked to wait 30 minutes, moving my feet and toes to help the dye travel up through my lymphatic system.

During the scan itself, an infrared camera held about 30 cm away from my legs displayed the real-time results on a small screen. In my left leg, two bright, clear lines, representing the dye moving through healthy lymphatic pathways, were visible from my foot all the way up to my groin. However, in my right leg, the scan showed only a few inches of these lines before they suddenly disappeared. Instead, a "starburst" or "galaxy-like" pattern appeared, indicating that the dye had not entered the superficial capillaries as expected. Despite this, the dye still managed to reach the groin, suggesting that some of the deeper lymphatic vessels (too deep to be seen via ICG) are functioning.

The next step in my treatment plan is to undergo a lymphoscintigraphy scan. This will evaluate how well the deeper lymphatic system is functioning. In simpler terms:

• If the deep lymphatics are working well, a less invasive surgical option may be appropriate

• If they're underperforming, a more complex and extensive procedure might be necessary

This consultation marked an important turning point for me, not only in terms of medical knowledge but also in feeling truly seen and understood as a whole person, not just a patient. I left with clearer direction and renewed determination.

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