Comparative analysis of superficial collecting lymph vessels in normal tissue and lymphedema using video-capillaroscopy

Abstract

Introduction

Lymphedema is a chronic, progressive disorder characterized by impaired lymphatic transport, tissue swelling, and fibrosis. This study used video-capillaroscopy, a high-resolution imaging technique, to assess superficial collecting lymphatic vessels and their vasa vasorum in patients with lymphedema. By comparing these microvascular structures to those in healthy tissue, we aimed to identify early vascular changes contributing to disease progression.

Methods

VC recordings were retrospectively analyzed from 28 limbs in 17 patients with lower extremity lymphedema and 53 lymphatic vessels in 12 cancer patients undergoing reconstructive surgery. In the latter group, observations were performed on normal subcutaneous tissue exposed at the donor site during flap harvest. These areas showed no tumor involvement, regional metastasis, or prior chemotherapy/radiotherapy. Thus, all normal tissue observations were made on untreated, unaffected sites. VCLs were classified into six stages (0–5) based on morphology and flow. Vessel diameter and red blood cell (RBC) velocity were measured. Statistical significance was set at p < 0.05.

Results

In normal donor tissue, mean VCL main vessel diameter and RBC velocity were 0.038 ± 0.031 mm and 185 ± 160.5 μm/s. In lymphedema, these values were reduced to 0.033 ± 0.024 mm and 28.3 ± 36.8 μm/s (p < 0.001). VCL Stage 0 showed preserved flow (p = 0.178), while Stages 1–5 exhibited progressive impairment.

Conclusion

These findings suggest that early ischemic changes in the vasa vasorum may precede lymphatic dysfunction and fibrosis in lymphedema. Preserving microvascular integrity should be a therapeutic focus, alongside drainage support. Further studies are needed to clarify clinical relevance and optimize treatment strategies.