Investigation of the Leg Lymphatic Function in Patients with Leg Acute Venous Thrombosis and in Patients with Leg Post-Thrombotic Syndrome

Abstract

Lymphatic and venous systems work together to drain interstitial fluid and blood respectively. Data on lymphatic function in chronic venous insufficiency and in chronic venous ulcerations are discordant. Modification of lymphatic function in acute venous thrombosis have been never described. The aim of this study is to report the modifications of the function of the lymphatic system in acute venous thrombosis, chronic venous ulceration and post-thrombotic syndrome. Material and Methods: Patients were studied with qualitative and semi-quantitative lymphoscintigraphy. The transport index (TI 60) have been calculated for each patients. Data obtained in group a (13 patients with acute venous thrombosis) (TI 60 = 398); group b (12 limbs of 6 controls) (TI 60 = 203); group c (10 limbs with chronic venous ulcerations) (TI 60 = 114); group d (6 limbs with post-thrombotic syndrome in absence of ulcerations) (TI 60 = 148) were compared with Kruscall-Wallis statistic and Mann-Whitney test. Results: The TI 60 is different in the four groups. Differences are significant between: group a (TI 60 = 398) and group b (TI 60 = 203); group b (TI 60 = 203) and group c (TI 60 = 114); group b (TI 60 = 203) and group d (TI 60 = 148). Discussion: The compensatory function of lymphatic system in acute venous thrombosis is definitively demonstrated. The lymphatic drainage of the limb affected by chronic venous ulceration is reduced. After the healing of the ulceration the lymphatic flow of the limbs affected by post-thrombotic syndrome improves but it remains under the levels of normal subjects.

Lower limb lymphatic flow and venous leg ulcers formation and healing

“…The review has been extensive and report important researches about physiological risk factors in venous ulcer formation (2). We would like to make a comment reporting the role of lower limb lymphatic system in the onset and the healing of chronic venous ulcers (3). In fact, venous and lymphatic systems work together to drain blood and interstitial fluids from the limb and, in case of post-thrombotic syndrome we were able to demonstrate, using lymphoscintigraphy, that the formation of venous ulcer is related to an impairment of the lymph flow and that, on the contrary the healing of the ulceration is related with and improvement of the lower limb lymphatic flow (3).…”

“…In fact, venous and lymphatic systems work together to drain blood and interstitial fluids from the limb and, in case of post-thrombotic syndrome we were able to demonstrate, using lymphoscintigraphy, that the formation of venous ulcer is related to an impairment of the lymph flow and that, on the contrary the healing of the ulceration is related with and improvement of the lower limb lymphatic flow (3). Elastic compression therapy, anticoagulation and mobilization enhance lymphatic drainage and improve healing rates (3)(4)(5). Psychosocial and physiological risk factors could include together with venous abnormalities, decreased mobility, fixed ankle joint, nutri-tion, ulcer duration, location and dimensions, wound exudation, wound infection and compression treatment (1) also the role of lymphatic drainage (3,4).…”

“…Elastic compression therapy, anticoagulation and mobilization enhance lymphatic drainage and improve healing rates (3)(4)(5). Psychosocial and physiological risk factors could include together with venous abnormalities, decreased mobility, fixed ankle joint, nutri-tion, ulcer duration, location and dimensions, wound exudation, wound infection and compression treatment (1) also the role of lymphatic drainage (3,4). In fact, a reduction in the lymphatic flow of the affected limb at lymphoscintigraphy is a negative predictive factor for wound healing, on the contrary an improvement of the lymph flow at lymphoscintigraphy is a positive predictive factor for wound closure (3,4).…”

“…Psychosocial and physiological risk factors could include together with venous abnormalities, decreased mobility, fixed ankle joint, nutri-tion, ulcer duration, location and dimensions, wound exudation, wound infection and compression treatment (1) also the role of lymphatic drainage (3,4). In fact, a reduction in the lymphatic flow of the affected limb at lymphoscintigraphy is a negative predictive factor for wound healing, on the contrary an improvement of the lymph flow at lymphoscintigraphy is a positive predictive factor for wound closure (3,4). In conclusion, lymphoscintigraphy could be an additive method of investigation to understand the mechanism of formation and healing of venous ulcers and it could be used, during the follow-up of these patients, to identify the progresses of a determinate treatment of the venous ulcers because when ulcer start to heal the lymph flow improves.…”

“…As Cariati (2010)'s study involved only eight participants with chronic venous ulceration and only in participants who had a venous ulceration duration of longer than 1 year, there is a need for further research in this area (1). As noted by Cariati (2010), there are few studies on the function of the lymphatic system in patients with chronic venous ulceration, however, existing research indicates that compression therapy can reduce local oedema and increase lymph flow (1). Therefore, any lymphstasis present in the legs with acute deep vein thrombosis or post-thrombotic syndrome is managed by the compression therapy involved in the wound management and preventive ongoing compression after wound healing.…”