Emerging evidence suggests that the lymphatics play an important role in the pathogenesis and progression of peripheral arterial and venous diseases. In two pilot studies, we sought to evaluate lymphatic function of patients with (i) late stage chronic venous disease (CVD) with active venous leg ulcers (VLUs) and (ii) early CVD and mild to moderate peripheral arterial disease (PAD) using near‐infrared fluorescence lymphatic imaging (NIRFLI).
After informed consent and under an FDA-approved IND for the off‐label administration of indocyanine green (ICG), each subjects received intradermal injections of ICG on the feet and legs. Imaging of lymphatic anatomy and pumping activity was performed by illuminating the legs with near-infrared light and collecting the resultant fluorescent light emanating from the ICG‐laden lymph using a custom imaging system. Data collection occurred in an outpatient setting between the dates of 2009 until present, with the study of early CVD and PAD subjects underway.
We observed abnormal lymphatic anatomy and reduced lymphatic pumping in all subjects enrolled in these two pilot studies. Observed abnormal lymphatic anatomy, as compared to previously imaged healthy subjects, included dermal lymphatic backflow as well as segmented, dilated and/or tortuous lymphatic vessels. Reduced lymphatic pumping was also observed in all subjects, and lymphatic reflux was noted in those subjects with an arterial component to their disease.
While these studies continue, evidence is mounting that lymphatic dysfunction is associated with the etiology of peripheral arterial and venous diseases.
Supported in parts by the National Institutes of Health R21 HL132598‐01 and Tactile Medical.
John C. Rasmussen, Banghe Zhu, Aaron D. Sahihi, Melissa B. Aldrich, Susan M. Pouliot, Stuart A. Harlin, Kristofer M. Charlton-Ouw, Caroline E. Fife, Thomas F. O'Donnell, and Eva M. Sevick-Muraca, "Visualizing lymphatic abnormalities in peripheral venous and arterial disease (Conference Presentation)," Proc. SPIE 10578, Medical Imaging 2018: Biomedical Applications in Molecular, Structural, and Functional Imaging, 105780G (Presented at SPIE Medical Imaging: February 11, 2018; Published: 14 March 2018); https://doi.org/10.1117/12.2293589.5751396625001.
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