Australian Lymphoedema Education, Research and Treatment (ALERT), Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia; Mount Wilga Private Hospital, Hornsby, NSW, Australia.
Australian Lymphoedema Education, Research and Treatment (ALERT), Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia.
J Vasc Surg Venous Lymphat Disord. 2022 Sep;10(5):1101-1106. doi: 10.1016/j.jvsv.2022.04.017. Epub 2022 Jun 15.
Retrograde movement of lymph owing to damaged and/or incompetent valves in the lymphatic vessels has been considered a pathological feature of lymphedema. This study aimed to determine the prevalence of retrograde lymph flow and the characteristics of patients with this condition using indocyanine green (ICG) lymphography.
An audit of 679 patients with upper or lower limb swelling who underwent ICG lymphography was undertaken over a 4-year period. Harvey's technique was applied to identify retrograde flow in the lymph collecting vessel during ICG lymphography. The characteristics of patients with retrograde lymph flow were recorded.
Twenty-one patients (3.7%; lower limb, n = 19; upper limb, n = 2) were identified as having retrograde flow in lymph collecting vessels out of 566 confirmed lymphedema patients (lower limb, n = 275; upper limb, n = 291). Of the two patients with upper limb lymphedema (ULLE), one had a short segment of retrograde lymph flow in the forearm. The other patient with ULLE and one patient with lower limb lymphedema (LLLE) were previously diagnosed with lymphedema-distichiasis syndrome. Of the remaining 18 patients with LLLE and retrograde lymph flow, nine had initiating insect bites with lymphangitis and three had palpable benign enlarged inguinal lymph nodes evident before lower limb swelling onset. None had cancer-related LLLE.
Retrograde lymph flow with valve incompetence in the lymph-collecting vessels was a rare finding in ULLE and a relatively uncommon finding in LLLE, contradicting the conventional understanding of pathological changes in lymphedema. ICG lymphography identified anticipated retrograde lymph flow in two patients with lymphedema distichiasis. In the remaining patients, retrograde lymph flow may have resulted from toxic or asymptomatic lymphangitis but there was no association with secondary cancer-related lymphedema. These findings have implication for conservative management as well as lymphovenous anastomosis surgery where both ends of a transected lymph collecting vessel would be potential targets for anastomoses.
淋巴管中受损和/或功能不全的瓣膜导致的淋巴逆流已被认为是淋巴水肿的病理特征。本研究旨在通过吲哚菁绿（ICG）淋巴造影术来确定逆流淋巴的流行率以及具有此情况的患者的特征。
在 4 年期间，对 679 名上肢或下肢肿胀患者进行了 ICG 淋巴造影术的审核。Harvey 技术被应用于在 ICG 淋巴造影术中识别淋巴收集管中的逆流。记录具有逆流淋巴的患者的特征。
在 566 例确诊的淋巴水肿患者（下肢，n=275；上肢，n=291）中，有 21 例（3.7%；下肢，n=19；上肢，n=2）被确定为具有淋巴收集管中的逆流。在 2 例上肢淋巴水肿（ULLE）患者中，有 1 例在前臂中出现短段的逆流淋巴。另一名 ULLE 患者和 1 例下肢淋巴水肿（LLLE）患者先前被诊断为淋巴水肿-多毛症综合征。在其余 18 例具有 LLLE 和逆流淋巴的患者中，有 9 例在下肢肿胀出现之前有起始性昆虫叮咬伴淋巴管炎，有 3 例有可触及的良性增大的腹股沟淋巴结。没有癌症相关的 LYLE。
淋巴收集管中瓣膜功能不全导致的逆流淋巴在 ULLE 中是一种罕见的发现，在 LYLE 中则是相对不常见的发现，这与淋巴水肿的病理变化的传统理解相矛盾。ICG 淋巴造影术在 2 例淋巴水肿多毛症患者中识别出预期的逆流淋巴。在其余患者中，逆流淋巴可能是由毒性或无症状的淋巴管炎引起的，但与继发性癌症相关的淋巴水肿无关。这些发现对保守治疗以及淋巴管静脉吻合术都有影响，因为淋巴管的两个断端都是吻合的潜在目标。
