[en] BACKGROUND: The existence of intratissular lymphaticovenous anastomoses has often been suggested, but it has never been demonstrated. This study aims at demonstrating the presence of such anastomoses. METHODS AND RESULTS: The free flap model was used to investigate the drainage of radiolabeled colloid particles whose size prevents direct passage to the blood vessels. The tracer was injected into the muscle or the skin during the surgical procedure. Blood samples were sequentially drawn from the venous pedicle over the 30 minutes that followed the tracer injection. The blood samples were counted using a gamma well-counter. In all 14 patients, the venous blood radioactivity steadily increased over time. Radiochemical analyses performed on the blood samples demonstrated that the radioactivity is related to the labeled colloids and not to free pertechnetate. Planar imaging performed 24 hours after the surgical procedure showed a significant liver uptake, and no accumulation in the area of normal lymphatic relays. CONCLUSIONS: As, in the free flap model, there is no lymphatic drainage through the classical pathways whatsoever, and since the size of the radiolabeled particles prevents them from directly entering the blood stream, the results strongly suggest the presence of functional intratissular lymphovenous anastomoses.
Disciplines :
Radiology, nuclear medicine & imaging
Author, co-author :
Heymans, Olivier
Fallais, Charles ; Université de Liège - ULiège > Département de pharmacie > Analyse des médicaments
Hustinx, Roland ; Université de Liège - ULiège > Département des sciences cliniques > Médecine nucléaire
Language :
English
Title :
Intratissular Lymphaticovenous Anastomoses Demonstrated by Perioperative Intramuscular Injection of 99mtc-Colloids
Van Trappen PO, Peper MS. Lymphatic dissemination of tumor cells and the formation of micrometastases. Lancet Oncol 2002;3:44-52.
Stacker SA, Baldwin ME, Achen MC. The role of tumor lymphangiogenesis in metastatic spread. FASEB J. 2002;16:922-934.
Hidden G, Menard P, Zorn JY. Lymphaticovenous communications. Role of the lymph nodes. Anat Clin 1985;7:83-91.
Fokin AA, Robicsek F, Masters TN, Schmid-Schönbein GW, Jenkins SH. Propagation of viral-size particle in lymph and blood after subcutaneous inoculation. Microcirculation 2000;7:193-200.
Ganon W. Review of Medical Physiology, 19th ed. Stamford, CT: Appleton and Lange: 1999:550-567.
Higuchi M., Fokin A, Masters TN, Robicsek F, Schmid-Schonbein GW. Transport of colloidal particles in lymphatics and vasculature after subcutaneous injection. J Appl Physiol 1999;86:1381-1397.
Stanton AWB, Svensson WE, Mellor RH, Peters AM, Levick JR, Mortimer PS. Differences in lymph drainage between swollen and nonswollen regions in arms with breast-cancer-related lymphoedema. Clin Sci 2001;101: 131-140.