Rockson SG
Journal of the American College of Cardiology. Date of publication 2008 Sep 2;volume 52(10):799-806.
1. J Am Coll Cardiol. 2008 Sep 2;52(10):799-806. doi: 10.1016/j.jacc.2008.06.005.
Diagnosis and management of lymphatic vascular disease.
Rockson SG(1).
Author information:
(1)Stanford Center for Lymphatic and Venous Disorders, Division of Cardiovascular
Medicine, Stanford University School of Medicine, Stanford, California 94305,
USA. srockson@cvmed.stanford.edu
The lymphatic vasculature is comprised of a network of vessels that is essential
both to fluid homeostasis and to the mediation of regional immune responses. In
health, the lymphatic vasculature possesses the requisite transport capacity to
accommodate the fluid load placed upon it. The most readily recognizable
attribute of lymphatic vascular incompetence is the presence of the
characteristic swelling of tissues, called lymphedema, which arises as a
consequence of insufficient lymph transport. The diagnosis of lymphatic vascular
disease relies heavily upon the physical examination. If the diagnosis remains in
question, the presence of lymphatic vascular insufficiency can be ascertained
through imaging, including indirect radionuclide lymphoscintigraphy. Beyond
lymphoscintigraphy, clinically-relevant imaging modalities include magnetic
resonance imaging and computerized axial tomography. The state-of-the-art
therapeutic approach to lymphatic edema relies upon physiotherapeutic techniques.
Complex decongestive physiotherapy is an empirically-derived, effective,
multicomponent technique designed to reduce limb volume and maintain the health
of the skin and supporting structures. The application of pharmacological
therapies has been notably absent from the management strategies for lymphatic
vascular insufficiency states. In general, drug-based approaches have been
controversial at best. Surgical approaches to improve lymphatic flow through
vascular reanastomosis have been, in large part, unsuccessful, but controlled
liposuction affords lasting benefit in selected patients. In the future,
specifically engineered molecular therapeutics may be designed to facilitate the
controlled regrowth of damaged, dysfunctional, or obliterated lymphatic
vasculature in order to circumvent or mitigate the vascular insufficiency that
leads to edema and tissue destruction.
DOI: 10.1016/j.jacc.2008.06.005
PMID: 18755341 [Indexed for MEDLINE]
