OBJECTIVES: This systematic review aims to evaluate the use of Indocyanine Green Lymphography (ICGL) for the investigation of the lymphatics in the lower limbs of primary lymphoedema patients. METHODS: MEDLINE and EMBASE articles from 01/01/2000 to 01/09/2023 were searched for. A total of 11 studies were included in the review after a two-stage screening process. RESULTS: Data on patient demographics, ICG contrast injection technique, imaging protocols and imaging outcomes were summarised and reviewed in detail. The review highlights the lack of commonality in protocols used. Factors important for good imaging are highly variable, particularly the number of injections, their location and whether they are delivered intradermally or subcutaneously. CONCLUSIONS: ICGL has strong potential to become a diagnostic tool to diagnose lymphoedema, due to its non-ionising nature and cost-effectiveness. However due to the lack of thorough phenotyping and genotyping of patients included in the studies, uncertainty still exists as to the value of the described imaging features such as splash, starburst and diffuse dermal rerouting patterns. Future studies, therefore, should aim to explore the diagnostic utility of ICGL for lymphoedema further through the imaging of primary lymphoedema patients with a confirmed genetic diagnosis and using standardised imaging protocols. ADVANCES IN KNOWLEDGE: ICGL is a strong candidate for advancing the diagnosis and understanding of primary lymphoedema, and monitoring response to treatment, but protocol heterogeneity and a lack of consistency in reporting imaging details and patient phenotyping currently hold it back.