Lymphatic Vessel Thrombosis in a Patient with Secondary Lymphedema

Hara, Hisako; Mihara, Makoto; Ohtomo, Rie; Tanaka, Sayuri

doi:10.1097/gox.0000000000002268

Cited by 11 publications

(9 citation statements)

References 16 publications

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“…These data indicate that not only do PEVs have functions in the blood but they can also affect pathologies in these locations within the body. This is particularly important when considering the possibility of PEVs affecting coagulation outside the blood in pathologic conditions [ 107 , 108 , 109 , 110 , 111 , 112 , 113 , 114 , 115 , 116 , 117 , 118 ]. In particular, PEVs may play a large role in the coagulation of lymphatic fluid, which is normally a hypocoagulable fluid due to the paucity of phospholipids [ 107 ].…”

Section: Platelet-derived Extracellular Vesicles Under Disease Condit...mentioning

confidence: 99%

“…Since different stimuli result in different numbers and phenotypic expression/contents of PEVs, it is important to know how PEVs are being generated in different disease states as well as to know how different agonists and therapies affect PEVs. Intriguingly, coagulation can also occur in fluid other than that of blood, including the bone marrow [ 108 ], the CNS [ 109 , 110 , 111 ], the lymphatic system [ 107 , 115 , 116 , 117 , 118 ], and the synovial fluid [ 112 , 113 , 114 , 156 ] in pathologic conditions. This occurs due to leakage of clotting factors and PEVs into these fluids allowing for coagulation, but very little has been studied about the roles of PEVs in coagulation outside the blood.…”

Section: Future Directionsmentioning

confidence: 99%

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The Role of Platelet-Derived Extracellular Vesicles in Immune-Mediated Thrombosis

Eustes

Dayal

2022

IJMS

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Platelet-derived extracellular vesicles (PEVs) play important roles in hemostasis and thrombosis. There are three major types of PEVs described based on their size and characteristics, but newer types may continue to emerge owing to the ongoing improvement in the methodologies and terms used to define various types of EVs. As the literature on EVs is growing, there are continuing attempts to standardize protocols for EV isolation and reach consensus in the field. This review provides information on mechanisms of PEV production, characteristics, cellular interaction, and their pathological role, especially in autoimmune and infectious diseases. We also highlight the mechanisms through which PEVs can activate parent cells in a feedback loop.

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Section: Platelet-derived Extracellular Vesicles Under Disease Condit...mentioning

confidence: 99%

Section: Future Directionsmentioning

confidence: 99%

The Role of Platelet-Derived Extracellular Vesicles in Immune-Mediated Thrombosis

Eustes

Dayal

2022

IJMS

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“…Activated factor X stimulates to production of prothrombinand formations of thrombin, which facilitates the conversion of a large amount of fibrinogen to fibrin. Eventually, this process leads to the formation of a compact mass of fibrin containing lymphoid cells ( 43 , 46 , 49 , 50 ) ( Figure 1B ). The formation of lymphatic thrombosis are supported by the release of thromboplastin substances from the injured lymphatic endothelium and the chronic obstruction of lymph flow in the presence of a hypercoagulable milieu, thus mirroring the Virchow's triad (hypercoagulability, stasis and endothelial injury) ( 5 , 51 ).…”

Section: Formation Of Lymphatic Thrombosismentioning

confidence: 99%

“…It is well-known that the platelets play an essential role in the formation of white thrombus in circulating blood ( 30 ). The lymph contains noplatelets yet it is known that thrombosis may occurwithin lymphatics ( 42 , 50 , 51 ). Although platelets are absent from the lymph, the human thoracic duct lymph contains phospholipidcomponents similar to those present at the plateletsurface.…”

Section: Different Hemostatic Properties For Lymphatic and Blood Coagulationmentioning

confidence: 99%

“…One possibility is that lymphatic thrombosis develops first and induces lymphedema. Another possibility is that lymphatic stasis and lymphedema develop first, and thrombus forms due to reduced low flow in the occluded lymphatic vessels ( 50 ). Nevertheless, it is certain that the edema is caused, at least in part, by interruption of lymphatic flow ( 42 , 49 ).…”

Section: Lymphatic Thrombosis-related Diseasesmentioning

confidence: 99%

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Coagulation in Lymphatic System

Zhang

Liang

et al. 2021

Front. Cardiovasc. Med.

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The lymphatic system maintains homeostasis of the internal environment between the cells in tissues and the blood circulation. The coagulation state of lymph is determined by conditions of coagulation factors and lymphatic vessels. Internal obliteration, external compression or abnormally increased lymphatic pressure may predispose to localized lymphatic coagulation. In physiological conditions, an imbalance of antithrombin and thrombokinase reduces lymphatic thrombosis. However, the release of factor X by lymphatic endothelium injury may trigger coagulation casacade, causing blockage of lymphatic vessels and lymphedema. Heterogeneity of lymphatic vessels in various tissues may lead to distinct levels and patterns of coagulation in specific lymphatic vessels. The quantitative and qualitative measurement of clotting characteristic reveals longer time for clotting to occur in the lymph than in the blood. Cancer, infections, amyloidosis and lymph node dissection may trigger thrombosis in the lymphatic vessels. In contrast to venous or arterial thrombosis, lymphatic thrombosis has rarely been reported, and its actual prevalence is likely underestimated. In this review, we summarize the mechanisms of coagulation in lymphatic system, and discuss the lymphatic thrombosis-related diseases.

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Lymphatic refill in ultrasound and lymphatic washout after lymphaticovenous anastomosis

Hara

Mihara

2022

Microsurgery

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Background: Lymphaticovenous anastomosis (LVA) drains lymph accumulated in the lymphatic vessels into the veins (lymphatic washout). A method to identify the ideal lymphatic vessels to achieve washout has not been established. This study examined the relationship between lymphatic washout, lymphatic ultrasonographic findings, and surgical outcomes. Methods:We reviewed consecutive patients who underwent LVA for lower limb lymphedema between September 2020 and March 2021. Patients who lacked data were excluded. Preoperative ultrasonography was performed to measure the lymphatic diameter. After the probe was pressed against the skin and released, the reaction of the lymphatic vessels was classified as either refilled, crushed, undecidable, or solid. Intraoperatively, whether lymphatic washout was observed or not, was recorded and compared to preoperative findings using the chi-square test. In 54 limbs from 32 patients, the total number of LVA, number of anastomoses with washout, number of refills detected by ultrasound, and severity of lymphedema were compared with the surgical result (postoperative limb volume change) by multiple regression analysis (49 limbs whose pre-or postoperative circumference data were lacking or who underwent intensive compression therapy postoperatively were excluded).Results: Sixty-five patients were reviewed. After excluding six patients with missing data, 59 patients (103 limbs) were included. The median patient age was 63 years (interquartile range, 51-76 years). We performed LVA at 217 sites (mean, 2.1 anastomoses per limb). "Refilled" lymphatics were observed at 156 sites (71.6%) and significantly thicker than those classified as "undecidable" (p = .020 in the lower leg and p < .001 in the thigh). In the thigh, "refilled" lymphatics had a higher rate of a washout than those classified as "undecidable." In Pearson's correlation coefficient for the surgical result, as the number of washout positive LVA increased, the limb volume tended to decrease postoperatively (correlation coefficient: À0.25). However, multiple regression analysis did not identify any factors that significantly affected the surgical outcomes.Conclusion: "Refilled" lymphatic vessels had a higher rate of intraoperative lymphatic washout after anastomosis.

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Lymphatic Vessel Thrombosis in a Patient with Secondary Lymphedema

Abstract: Supplemental Digital Content is available in the text.

Cited by 11 publications

References 16 publications

The Role of Platelet-Derived Extracellular Vesicles in Immune-Mediated Thrombosis

The Role of Platelet-Derived Extracellular Vesicles in Immune-Mediated Thrombosis

Coagulation in Lymphatic System

Lymphatic refill in ultrasound and lymphatic washout after lymphaticovenous anastomosis

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