Evaluation of the Superficial Collecting Lymph Vessels' Vasa Vasorum in Lymphoedematous Limbs Using Video Capillaroscopy

Chihiro Matsui; Reiko Tsukuura; Hayahito Sakai; Joseph M Escandón; Arbab Mohammad; Takumi Yamamoto

doi:10.1016/j.ejvs.2023.11.035

Evaluation of the Superficial Collecting Lymph Vessels' Vasa Vasorum in Lymphoedematous Limbs Using Video Capillaroscopy

Eur J Vasc Endovasc Surg. 2023 Nov 23:S1078-5884(23)00965-6. doi: 10.1016/j.ejvs.2023.11.035. Online ahead of print.

Authors

Chihiro Matsui¹, Reiko Tsukuura², Hayahito Sakai², Joseph M Escandón³, Arbab Mohammad⁴, Takumi Yamamoto⁵

Affiliations

¹ Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, National Centre for Global Health and Medicine, Tokyo, Japan.
² Department of Plastic and Reconstructive Surgery, National Centre for Global Health and Medicine, Tokyo, Japan.
³ Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Centre, New York, NY, USA.
⁴ Aarupadai Veedu Medical College and Hospital, Puducherry, India.
⁵ Department of Plastic and Reconstructive Surgery, National Centre for Global Health and Medicine, Tokyo, Japan. Electronic address: tyamamoto-tky@umin.ac.jp.

PMID: 38000693
DOI: 10.1016/j.ejvs.2023.11.035

Abstract

Objective: The pre-collecting and collecting lymph vessels have smooth muscle cells, and sufficient perfusion is vital to maintain their function. Although the vasa vasorum of the collecting lymph vessels (VVCL) have been histologically investigated, little is known about their physiology. This study aimed to investigate the relationship between morphology and blood flow of the VVCL in lymphoedematous limbs.

Methods: Medical records of lower extremity lymphoedema patients who underwent video capillaroscopy observation during supermicrosurgical lymphaticovenous anastomosis (LVA) surgery were reviewed. The collecting lymph vessels, dissected for LVA, were examined under video capillaroscopy (GOKO Bscan-ZD, GOKO Imaging Devices Co., Japan) with a magnification of 175x and 620x. Blood flow velocity of the VVCL was calculated by measuring the red blood cell movement using software (GOKO-VIP ver. 1.0.0.4, GOKO Imaging Devices Co., Japan). Based on the video capillaroscopy findings, the VVCL were grouped according to their morphology; the VVCL morphology types and blood flow velocity were then compared according to the lymphosclerosis severity grade.

Results: Sixty-seven lymph vessels in 20 lower extremity lymphoedema patients were evaluated, including s0 in 19 (28.4%), s1 in 34 (50.7%), s2 in 10 (14.9%), and s3 in four (6.0%) lymph vessels. The VVCLs were grouped into four types: type 1 (n = 4), type 2 (n = 37), type 3 (n = 19), and type 4 (n = 7). Blood flow velocity of the VVCL ranged 0 - 189.3 μm/sec (average 26.40 μm/sec). There were statistically significant differences in VVCL morphology (p < .001) and blood flow velocity (p < .001) according to lymphosclerotic severity.

Conclusion: Vasa vasorum of the collecting lymph vessels could be grouped into four types with different characteristics. Morphological and physiological changes of the VVCL were related to sclerotic changes of the collecting lymph vessels.

Keywords: Lymphatic system; Lymphoedema; Lymphography; Microsurgery; Vasa vasorum.