Effect of venous and lymphatic congestion on lymph capillary pressure of the skin in healthy volunteers and patients with lymph edema

The aim of the present study was to assess the influence of venous and lymp hatic congestion on lymph capillary pressure (LCP) in the skin of the foot dorsum of healthy volunteers and of patients with lymph edema. LCP was meas ured at the foot dorsum of 12 patients with lymph edema and 18 healthy volu nteers using the servo-nulling technique. Glass micropipettes (7-9 mu m) we re inserted under microscopic control into lymphatic microvessels visualize d by fluorescence microlymphography before and during venous congestion. Ve nous and lymphatic congestion was attained by cuff compression (50 mm Hg) a t the thigh level. Simultaneously, the capillary filtration rate was measur ed using strain gauge plethysmography. The mean LCP in patients with lymph edema increased significantly (p < 0.05) during congestion (15.7 +/- 8.8 mm Hg) compared to the control value (12.2 +/- 8.9 mm Hg). The corresponding values of LCP in healthy volunteers were 4.3 +/- 2.6 mm Hg during congestio n and 2.6 +/- 2.8 mm Hg during control conditions (p < 0.01), The mean incr ease in LCP in patients with lymph edema was 3.4 +/- 4.1 mm Hg, and 1.7 +/- 2.0 mm Hg in healthy volunteers (NS). The maximum spread of the lymph capi llary network in patients increased from 13.9 +/- 6.8 mm before congestion to 18.8 +/- 8.2 mm during thigh compression (p < 0.05). No increase could b e observed in healthy subjects. In summary, venous and lymphatic congestion by cuff compression at the thigh level results in a significant increase i n LCP in healthy volunteers as well as in patients with lymph edema. The in creased spread of the contrast medium in the superficial microlymphatics in lymph edema patients indicates a compensatory mechanism for lymphatic drai nage during congestion of the veins and lymph collectors of the leg. Copyri ght (C) 2000 S. Karger AG, Basel.