Lymphatic overload and venous diseases

Abstract

The main circulatory function of the lymphatic system consists in bringing macro-molecules back into the blood circulation from the interstitial space of the sustaining lax connective tissue.

The authors have observed aspects of the lymphatic system in lower limbs injury in 25 patients with posthrombophlebitic syndrome (PTS) by means of: lymphangiochromy, lymphangiography with ultrafluid lipiodol, lymphographies with radioactively labeled macromolecules (RLM), and histologic examination of lymph vessels and lymph nodes and proteic and lipidic composition of edema fluid. They did not observe any obstacle in lymph circulation.

RLM resorption was diminished in cellulitis areas and absent in ulcus and hypotrophic sclerosing dermatitis areas. In edema liquid, proteins were less than 0.77 g%.

In the presence of PTS, the skin grows thinner and hypotrophic on the interior aspect of the calves and the hair also grows thinner and lessens. In contrast, from the clinical point of view, in patients with lymphedema, the skin of the calves becomes hypertrophic and the hair grows thicker and dense.

In some stages of PTS, lymphatic flow may increase. This increase generates the hypothesis of a false lymphatic overload syndrome. This remains a pseudosyndrome in the absence of perceptible histologic and functional alterations. This optical overload is generated by an increase in the extravascular liquid exodus following the alteration of venous circulation in the calves. The reaction to an increased load cannot be considered a disease of the structure responding to overload.