Lymphatic Anatomy and Physiology

Abstract

Lymphatics have long been overshadowed by the remainder of the circulatory system. Historically, lymphatics were difficult to study because of their small and indistinct vessels, colorless fluid contents, and limited effective interventions. However, the past several decades have brought increased funding, advanced imaging technologies, and novel interventional techniques to the field. Understanding the history of lymphatic anatomy and physiology is vital to further realize the role lymphatics play in most major disease pathologies and innovate interventional solutions for them.

Minimal invasive treatment for post‐liver and renal transplant lymphatic leaks

“…Specifically, creatinine levels were assessed for renal transplant patients to rule out urine leakage. Since absorbed dietary fats are delivered into the para‐aortic lymphatics and to liver sinusoid via the portal vein, which are downstream to the iliac surgical field for a renal transplant, the usual diagnostic criterion of an elevated triglyceride (TG) to > 250 mg/dL was not applicable to these cases 8 . While leakage from hepatic lymph usually contains high TG and protein levels, therefore, analysis of these levels is essential in liver transplant patients to rule out biliary leak or seroma.…”

“…Three major lymph compartments, namely the peripheral, intestinal, and hepatic lymphatics coalesce at the abdominal level. 8 The peripheral lymphatics drain through bilateral lumbar trunks converging into the cisterna chyli at retroperitonium, through the thoracic duct in the posterior mediastinum, and finally, into the left jugular-subclavian veinous junction. The intestinal and hepatic lymphatics originate from the intestine, then either enters the hepatic sinusoid and form the hepatic lymph, or directly drain into the cisterna chyli and thoracic duct.…”

An update on oral drug delivery via intestinal lymphatic transport

“…Generally, they originate from the lacteals and submucosal lymphatic networks and develop into inter-follicular regions, forming basket-like shape by encircling the medium-basal part of each Peyer's patch 49 , 50 . The lymphatics always run along with blood vessels; both of them are abundant in peri-follicular and inter-follicular regions but rare in germinal centers except for a few tiny branches 51 , 52 . Each Peyer's patch has a drainage pathway with distinct pre-collectors reaching the same destination as the lacteals 52 .…”

Imaging of fluorescent polymer dots in relation to channels and immune cells in the lymphatic system

“…The system is responsible for maintaining tissue fluid balance, and serves as a conduit for immune cell transportation and dietary fat uptake in the intestine [ 1 , [3] , [4] , [5] , [6] ]. This fascinating vasculature is now thought to be dynamically and actively involved in health and disease [ [7] , [8] , [9] ].…”