Effect of Venous and Lymphatic Congestion on Lymph Capillary Pressure of the Skin in Healthy Volunteers and Patients with Lymph Edema

Abstract

The aim of the present study was to assess the influence of venous and lymphatic congestion on lymph capillary pressure (LCP) in the skin of the foot dorsum of healthy volunteers and of patients with lymph edema. LCP was measured at the foot dorsum of 12 patients with lymph edema and 18 healthy volunteers using the servo-nulling technique. Glass micropipettes (7–9 μm) were inserted under microscopic control into lymphatic microvessels visualized by fluorescence microlymphography before and during venous congestion. Venous and lymphatic congestion was attained by cuff compression (50 mm Hg) at the thigh level. Simultaneously, the capillary filtration rate was measured using strain gauge plethysmography. The mean LCP in patients with lymph edema increased significantly (p < 0.05) during congestion (15.7 ± 8.8 mm Hg) compared to the control value (12.2 ± 8.9 mm Hg). The corresponding values of LCP in healthy volunteers were 4.3 ± 2.6 mm Hg during congestion and 2.6 ± 2.8 mm Hg during control conditions (p < 0.01). The mean increase in LCP in patients with lymph edema was 3.4 ± 4.1 mm Hg, and 1.7 ± 2.0 mm Hg in healthy volunteers (NS). The maximum spread of the lymph capillary network in patients increased from 13.9 ± 6.8 mm before congestion to 18.8 ± 8.2 mm during thigh compression (p < 0.05). No increase could be observed in healthy subjects. In summary, venous and lymphatic congestion by cuff compression at the thigh level results in a significant increase in LCP in healthy volunteers as well as in patients with lymph edema. The increased spread of the contrast medium in the superficial microlymphatics in lymph edema patients indicates a compensatory mechanism for lymphatic drainage during congestion of the veins and lymph collectors of the leg.

Modulation of lymphatic muscle contractility by the neuropeptide substance P

“…Regardless, in vivo lymphatics, which contract neither isometrically nor isobarically (due to internal pressure spikes), would be stimulated by the additive effects of pressure and low doses of SP to promote vigorous changes in lymphatic pumping. Under conditions of edemagenic stress, when both pressure and local SP levels are most likely to be elevated, the inotropic and chronotropic actions of SP would allow the pumping ability of the collecting lymphatics to be preserved or even enhanced in the face of chronically elevated intraluminal pressure (3,14,20,37,48).…”

“…The effect of SP on tone may be important pathologically because, at very high intraluminal pressures associated with chronic edema (3,14,20,37,48), the normal uphill pressure gradient (16,17) may be reversed and collecting lymphatics may switch, over a prolonged period of time, from functioning as pumps to serving as conduits (12,38). Although this effect might be advantageous to interstitial fluid balance at moderately elevated interstitial and lymphatic pressures, excessive basal tone development promoted by SP could be disadvantageous by increasing the resistance of the collecting lymphatic conduits and potentially exacerbating the edema.…”

An investigation of lymphovenous communications in the upper limbs of breast cancer patients

“…It has been suggested that they open in response to lymphatic hypertension following axillary nodal surgery and provide a protective effect against lymphoedema. 4,5 Thus, local vascular clearance of lymph via peripheral LVCs would potentially diminish or prevent breast cancer-related lymphoedema (BCRL).…”

Efficacy of Topical Treatment with Aescin + Essential Phospholipids Gel in a Microcirculatory Model of Venous Insufficiency

“…The histamine model has been previously described and applied in several conditions, including chronic venous hypertension. [1][2][3] With iontophoresis, AEPL penetration increases (under the action of the electric field) approximately ten times. The diffusion of AEPL occurs at a very fast rate and its actions become immediately effective.…”