Bendon Charlotte L, Hanssen Eric, Nowell Cameron, Karnezis Tara, Shayan Ramin
From The O'Brien Institute Department, St Vincent's Institute for Medical Research, Fitzroy, Victoria, Australia.
Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia.
Plast Reconstr Surg Glob Open. 2024 Jan 24;12(1):e5547. doi: 10.1097/GOX.0000000000005547. eCollection 2024 Jan.
Lymphedema is common after lymphatic damage in cancer treatment, with negative impacts on function and quality of life. Evidence suggests that blood vessel microvasculature is sensitive to irradiation and trauma; however, despite knowledge regarding dedicated mural blood supply to arteries and veins (vasa vasorum), equivalent blood vessels supplying lymphatics have not been characterized. We studied collecting lymphatics for dedicated mural blood vessels in our series of 500 lymphaticovenous anastomosis procedures for lymphedema, and equivalent controls.
Microscopic images of lymphatics from lymphedema and control patients were analyzed for lymphatic wall vascular density. Collecting lymphatics from 20 patients with lymphedema and 10 control patients were sampled for more detailed analysis (podoplanin immunostaining, light/confocal microscopy, microcomputed tomography, and transmission electron microscopy) to assess lymphatic wall ultrastructure and blood supply.
Analysis revealed elaborate, dense blood microvessel networks associating with lymphatic walls in lymphedema patients and smaller equivalent vessels in controls. These vasa vasora or "arteria lymphatica" were supplied by regular axial blood vessels, parallel to lymphatic microperforators linking dermal and collecting lymphatics. Lymphatic walls were thicker in lymphedema patients than controls, with immunohistochemistry, computed tomography, transmission electron microscopy, and confocal microscopy characterizing abnormal blood vessels (altered appearance, thickened walls, elastin loss, narrow lumina, and fewer red blood cells) on these lymphatic walls.
Dedicated blood vessels on lymphatics are significantly altered in lymphedema. A better understanding of the role of these vessels may reveal mechanistic clues into lymphedema pathophysiology and technical aspects of lymphedema microsurgery, and suggest potential novel therapeutic targets.
淋巴水肿在癌症治疗导致淋巴管损伤后很常见，对功能和生活质量有负面影响。有证据表明血管微血管对辐射和创伤敏感；然而，尽管人们了解动脉和静脉有专门的壁内血液供应（血管滋养管），但供应淋巴管的类似血管尚未得到明确描述。在我们为治疗淋巴水肿而进行的500例淋巴管静脉吻合手术系列中，我们研究了收集淋巴管的专门壁内血管，并设置了相应对照。
分析淋巴水肿患者和对照患者淋巴管的显微图像，以测定淋巴管壁血管密度。对20例淋巴水肿患者和10例对照患者收集的淋巴管进行更详细分析（血小板内皮细胞黏附分子免疫染色、光镜/共聚焦显微镜检查、微型计算机断层扫描和透射电子显微镜检查），以评估淋巴管壁超微结构和血液供应。
分析显示，淋巴水肿患者的淋巴管壁有精细、密集的微血管网络，而对照患者的相应血管较小。这些血管滋养管或“淋巴管动脉”由规则的轴向血管供应，与连接真皮和收集淋巴管的淋巴管微穿支平行。淋巴水肿患者的淋巴管壁比对照患者的厚，免疫组织化学、计算机断层扫描、透射电子显微镜和共聚焦显微镜检查显示这些淋巴管壁上的血管异常（外观改变、壁增厚、弹性蛋白丢失、管腔狭窄和红细胞减少）。
淋巴水肿患者淋巴管上的专门血管有显著改变。更好地了解这些血管的作用可能会揭示淋巴水肿病理生理学和淋巴水肿显微手术技术方面的机制线索，并提示潜在的新治疗靶点。
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