LYMPHATIC AND TRANSCAPILLARY FORCES IN PATIENTS WITH EDEMA FOLLOWING OPERATION FOR LOWER LIMB ATHEROSCLEROSIS

Abstract

lntralymphatic end pressure and Starling pressures
(interstitial fluid pressure (Pif), plasma and interstitial
fluid colloid osmotic pressures (COPpl and
COPif)) were measured in leg subcutaneous tissue
in 5 patients with local leg edema following femoropopliteal
reconstruction for lower limb atherosclerosis.
Superficial lymphatics were cannulated proximal
to the ankle and the catheter was connected
to either syringes for determination of lymph flow
and colloid osmotic pressure (COPI), or to a pressure
transducer for measurement of intralymphatic
end pressure. Samples of interstitial fluid were collected
by implantation of nylon wicks and Pif was
measured by the "wick-in-needle" technique.
In all patients normal end pressure waves with maximum
values ranging between 30 and 40 mmHg were
recorded, indicating that the ischemia prior to surgery
had not significantly affected the intrinsic
mechanism for lymph propulsion. COPif of the
operated leg averaged 5.7 mmHg ± 1.0 which was
0.9 mmHg ± 0.7 higher than the corresponding
COP1. This supports the theory of "preferential
channels" between the capillaries and the lymphatics.
There was a statistically significant correlation between
lymph flow and estimated capillary pressure
(reabsorption pressure) , capillary filtration coefficient,
calf blood flow and Pif· According to this
study the capillary pressure should at least be 11
mmHg before production of lymph occurs.