Lymphatic transport in patients with chronic venous insufficiency and venous leg ulcers following sequential pneumatic compression
Identifieur interne : 001B63 ( Main/Exploration ); précédent : 001B62; suivant : 001B64Lymphatic transport in patients with chronic venous insufficiency and venous leg ulcers following sequential pneumatic compression
Auteurs : John C. Rasmussen [États-Unis] ; Melissa B. Aldrich [États-Unis] ; I-Chih Tan [États-Unis] ; Chinmay Darne [États-Unis] ; Banghe Zhu [États-Unis] ; Thomas F. O'Donnell [États-Unis] ; Caroline E. Fife [États-Unis] ; Eva M. Sevick-Muraca [États-Unis]Source :
- Journal of vascular surgery. Venous and lymphatic disorders [ 2213-333X ] ; 2015.
Abstract
To assess lymphatics in subjects with venous leg ulcers using near-infrared fluorescence lymphatic imaging (NIRFLI) and to assess lymphatic impact of a single session of sequential pneumatic compression (SPC).
Recent advancements in NIRFLI technology provide opportunities for non-invasive, real-time assessment of lymphatic contribution in the etiology and treatment of ulcers.
Following intradermal microdoses of indocyanine green (ICG) as a lymphatic contrast agent, NIRFLI was used in a pilot study to image the lymphatics of 12 subjects with active venous leg ulcers (CEAP C6). The lymphatics were imaged before and after a single session of SPC to assess impact on lymphatic function.
Baseline imaging showed impaired lymphatic function and bilateral dermal backflow in all subjects with chronic venous insufficiency, even those without ulcer formation in the contralateral limb (C0 and C4 disease). SPC therapy caused proximal movement of ICG away from the active wound in 9 of 12 subjects, as indicated by newly recruited functional lymphatic vessels, emptying of distal lymphatic vessels, or proximal movement of extravascular fluid. Subjects with the longest duration of active ulcers had few visible lymphatic vessels and proximal movement of ICG was not detected after SPC therapy.
This study provides visible confirmation of lymphatic dysfunction at an early stage in the etiology of venous ulcer formation and demonstrates the potential therapeutic mechanism of SPC therapy in removing excess fluid. The ability of SPC therapy to restore fluid balance through proximal movement of lymph and interstitial fluid may explain its value in hastening venous ulcer healing. Anatomical differences between the lymphatics of longstanding and more recent venous ulcers may have important therapeutic implications.
Url:
DOI: 10.1016/j.jvsv.2015.06.001
PubMed: 26946890
PubMed Central: 4782606
Affiliations:
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Le document en format XML
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<front><div type="abstract" xml:lang="en"><sec id="S1"><title>Objective</title>
<p id="P1">To assess lymphatics in subjects with venous leg ulcers using near-infrared fluorescence lymphatic imaging (NIRFLI) and to assess lymphatic impact of a single session of sequential pneumatic compression (SPC).</p>
</sec>
<sec id="S2"><title>Background</title>
<p id="P2">Recent advancements in NIRFLI technology provide opportunities for non-invasive, real-time assessment of lymphatic contribution in the etiology and treatment of ulcers.</p>
</sec>
<sec id="S3"><title>Methods</title>
<p id="P3">Following intradermal microdoses of indocyanine green (ICG) as a lymphatic contrast agent, NIRFLI was used in a pilot study to image the lymphatics of 12 subjects with active venous leg ulcers (CEAP C<sub>6</sub>
). The lymphatics were imaged before and after a single session of SPC to assess impact on lymphatic function.</p>
</sec>
<sec id="S4"><title>Results</title>
<p id="P4">Baseline imaging showed impaired lymphatic function and bilateral dermal backflow in all subjects with chronic venous insufficiency, even those without ulcer formation in the contralateral limb (C<sub>0</sub>
and C<sub>4</sub>
disease). SPC therapy caused proximal movement of ICG away from the active wound in 9 of 12 subjects, as indicated by newly recruited functional lymphatic vessels, emptying of distal lymphatic vessels, or proximal movement of extravascular fluid. Subjects with the longest duration of active ulcers had few visible lymphatic vessels and proximal movement of ICG was not detected after SPC therapy.</p>
</sec>
<sec id="S5"><title>Conclusions</title>
<p id="P5">This study provides visible confirmation of lymphatic dysfunction at an early stage in the etiology of venous ulcer formation and demonstrates the potential therapeutic mechanism of SPC therapy in removing excess fluid. The ability of SPC therapy to restore fluid balance through proximal movement of lymph and interstitial fluid may explain its value in hastening venous ulcer healing. Anatomical differences between the lymphatics of longstanding and more recent venous ulcers may have important therapeutic implications.</p>
</sec>
</div>
</front>
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<affiliations><list><country><li>États-Unis</li>
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<tree><country name="États-Unis"><region name="Texas"><name sortKey="Rasmussen, John C" sort="Rasmussen, John C" uniqKey="Rasmussen J" first="John C." last="Rasmussen">John C. Rasmussen</name>
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<name sortKey="Aldrich, Melissa B" sort="Aldrich, Melissa B" uniqKey="Aldrich M" first="Melissa B." last="Aldrich">Melissa B. Aldrich</name>
<name sortKey="Darne, Chinmay" sort="Darne, Chinmay" uniqKey="Darne C" first="Chinmay" last="Darne">Chinmay Darne</name>
<name sortKey="Fife, Caroline E" sort="Fife, Caroline E" uniqKey="Fife C" first="Caroline E." last="Fife">Caroline E. Fife</name>
<name sortKey="O Donnell, Thomas F" sort="O Donnell, Thomas F" uniqKey="O Donnell T" first="Thomas F." last="O'Donnell">Thomas F. O'Donnell</name>
<name sortKey="Sevick Muraca, Eva M" sort="Sevick Muraca, Eva M" uniqKey="Sevick Muraca E" first="Eva M." last="Sevick-Muraca">Eva M. Sevick-Muraca</name>
<name sortKey="Tan, I Chih" sort="Tan, I Chih" uniqKey="Tan I" first="I-Chih" last="Tan">I-Chih Tan</name>
<name sortKey="Zhu, Banghe" sort="Zhu, Banghe" uniqKey="Zhu B" first="Banghe" last="Zhu">Banghe Zhu</name>
</country>
</tree>
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