John C Rasmussen1, Melissa B Aldrich1, I-Chih Tan1, Chinmay Darne1, Banghe Zhu1, Thomas F O'Donnell2, Caroline E Fife3, Eva M Sevick-Muraca4. 1. Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center at Houston, Houston, Tex. 2. Division of Vascular Surgery, Tufts Medical Center, Boston, Mass. 3. Wound Care Clinic, CHI St. Luke's Health - The Woodlands Hospital, The Woodlands, Tex. 4. Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center at Houston, Houston, Tex. Electronic address: eva.sevick@uth.tmc.edu.
Abstract
BACKGROUND: Recent advancements in near-infrared fluorescence lymphatic imaging (NIRFLI) technology provide opportunities for non-invasive, real-time assessment of lymphatic contribution in the etiology and treatment of ulcers. The objective of this study was to assess lymphatics in subjects with venous leg ulcers using NIRFLI and to assess lymphatic impact of a single session of sequential pneumatic compression (SPC). METHODS: Following intradermal microdoses of indocyanine green (ICG) as a lymphatic contrast agent, NIRFLI was used in a pilot study to image the lymphatics of 12 subjects with active venous leg ulcers (Clinical, Etiologic, Anatomic, and Pathophysiologic [CEAP] C6). The lymphatics were imaged before and after a single session of SPC to assess impact on lymphatic function. RESULTS: Baseline imaging showed impaired lymphatic function and bilateral dermal backflow in all subjects with chronic venous insufficiency, even those without ulcer formation in the contralateral limb (C0 and C4 disease). SPC therapy caused proximal movement of ICG away from the active wound in 9 of 12 subjects, as indicated by newly recruited functional lymphatic vessels, emptying of distal lymphatic vessels, or proximal movement of extravascular fluid. Subjects with the longest duration of active ulcers had few visible lymphatic vessels, and proximal movement of ICG was not detected after SPC therapy. CONCLUSIONS: This study provides visible confirmation of lymphatic dysfunction at an early stage in the etiology of venous ulcer formation and demonstrates the potential therapeutic mechanism of SPC therapy in removing excess fluid. The ability of SPC therapy to restore fluid balance through proximal movement of lymph and interstitial fluid may explain its value in hastening venous ulcer healing. Anatomical differences between the lymphatics of longstanding and more recent venous ulcers may have important therapeutic implications.
BACKGROUND: Recent advancements in near-infrared fluorescence lymphatic imaging (NIRFLI) technology provide opportunities for non-invasive, real-time assessment of lymphatic contribution in the etiology and treatment of ulcers. The objective of this study was to assess lymphatics in subjects with venous leg ulcers using NIRFLI and to assess lymphatic impact of a single session of sequential pneumatic compression (SPC). METHODS: Following intradermal microdoses of indocyanine green (ICG) as a lymphatic contrast agent, NIRFLI was used in a pilot study to image the lymphatics of 12 subjects with active venous leg ulcers (Clinical, Etiologic, Anatomic, and Pathophysiologic [CEAP] C6). The lymphatics were imaged before and after a single session of SPC to assess impact on lymphatic function. RESULTS: Baseline imaging showed impaired lymphatic function and bilateral dermal backflow in all subjects with chronic venous insufficiency, even those without ulcer formation in the contralateral limb (C0 and C4 disease). SPC therapy caused proximal movement of ICG away from the active wound in 9 of 12 subjects, as indicated by newly recruited functional lymphatic vessels, emptying of distal lymphatic vessels, or proximal movement of extravascular fluid. Subjects with the longest duration of active ulcers had few visible lymphatic vessels, and proximal movement of ICG was not detected after SPC therapy. CONCLUSIONS: This study provides visible confirmation of lymphatic dysfunction at an early stage in the etiology of venous ulcer formation and demonstrates the potential therapeutic mechanism of SPC therapy in removing excess fluid. The ability of SPC therapy to restore fluid balance through proximal movement of lymph and interstitial fluid may explain its value in hastening venous ulcer healing. Anatomical differences between the lymphatics of longstanding and more recent venous ulcers may have important therapeutic implications.
Authors: John C Rasmussen; I-Chih Tan; Milton V Marshall; Kristen E Adams; Sunkuk Kwon; Caroline E Fife; Erik A Maus; Latisha A Smith; Kyle R Covington; Eva M Sevick-Muraca Journal: Transl Oncol Date: 2010-12-01 Impact factor: 4.243
Authors: John C Rasmussen; Rodrick C Zvavanjanja; Melissa B Aldrich; Matthew R Greives; Eva M Sevick-Muraca Journal: J Vasc Surg Venous Lymphat Disord Date: 2017-07
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Authors: Stanley G Rockson; Xin Zhou; Lan Zhao; Davood K Hosseini; Xinguo Jiang; Andrew J Sweatt; Dongeon Kim; Wen Tian; Michael P Snyder; Mark R Nicolls Journal: Clin Transl Med Date: 2022-04
Authors: Fedor Lurie; Rafael D Malgor; Teresa Carman; Steven M Dean; Mark D Iafrati; Neil M Khilnani; Nicos Labropoulos; Thomas S Maldonado; Peter Mortimer; Thomas F O'Donnell; Joseph D Raffetto; Stanley G Rockson; Antonios P Gasparis Journal: Phlebology Date: 2022-03-08 Impact factor: 1.701
Authors: John C Rasmussen; Melissa B Aldrich; Caroline E Fife; Karen L Herbst; Eva M Sevick-Muraca Journal: Obesity (Silver Spring) Date: 2022-06-15 Impact factor: 9.298
Authors: John C Rasmussen; Banghe Zhu; John R Morrow; Melissa B Aldrich; Aaron Sahihi; Stuart A Harlin; Caroline E Fife; Thomas F O'Donnell; Eva M Sevick-Muraca Journal: J Vasc Surg Venous Lymphat Disord Date: 2020-09-22
Authors: Melissa B Aldrich; Fred C Velasquez; Sunkuk Kwon; Ali Azhdarinia; Kenneth Pinkston; Barrett R Harvey; Wenyaw Chan; John C Rasmussen; Russell F Ross; Caroline E Fife; E M Sevick-Muraca Journal: Arthritis Res Ther Date: 2017-05-31 Impact factor: 5.156