Objective　To explore the application of multipoint injection indocyanine green (ICG) lymphography in lymphaticovenular anastomosis (LVA) of lower limbs and analyze the advantages of the improved lymphography. Methods　From

December 2020 to June 2022, 57 patients with lower limb lymphedema were selected as the study subjects and were divided

into the single injection group (n=25) and the multi-injection group (n=32). In the single injection group, ICG was injected into

the first toe web. In the multi-point injection group, ICG was injected preoperatively at the first web, medial malleolus, lateral

malleolus, medial knee and lateral knee. The linear pattern was observed by ICG lymphography and LVA was performed in both

groups. The number of lymphatic vessels anastomosed and the time of surgery were compared. Lower extremity lymphedema

index (LELI) was used as the prognostic index, the symptom relief of lymphedema half a year after LVA was evaluated in both

groups. Results　The number of anastomotic lymphatic vessels in the multi-injection group was higher than that in the single

injection group, and the surgery time was lower than that in the single injection group (P<0.05). The LELI of the multi-injection

group and the single injection group half a year after LVA were lower than that before operation (P<0.05). The circumference of

the affected limb was reduced in both groups after operation, the reduction of LELI in the multi-point injection group was higher than that in the single injection group (P<0.05). Conclusion　Multipoint injection indocyanine green lymphography can find more pattern before operation and shorten the time of looking for lymphatic vessels, which has high clinical application value.

　Lower limb lymphedema, 　Lymphaticovenular anastomosis, 　Indocyanine green, 　Lymphography, 　Multi