Near-Infrared Fluorescence Lymphatic Imaging to Reconsider Occlusion Pressure of Superficial Lymphatic Collectors in Upper Extremities of Healthy Volunteers

Abstract

Background: There are very little scientific data on occlusion pressure for superficial lymphatic collectors. Given its importance in determining the transport capacity of lymphatic vessels, it is crucial to know its value. The novel method of near-infrared fluorescence lymphatic imaging (NIRFLI) can be used to visualize lymphatic flow in real time. The goal of this study was to see if this method could be used to measure the lymphatic occlusion pressure.Methods: We observed and recorded lymph flow in the upper limb of healthy volunteers through a transparent cuff using near-infrared fluorescence lymphatic imaging. After obtaining a baseline of the lymph flow without pressure inside the cuff, the cuff was inflated by increments of 10 mm Hg starting at 30 mm Hg. A NIRFLI guided manual lymphatic drainage technique named “Fill & Flush Drainage Method” was performed during the measurement to promote lymph flow. Lymphatic occlusion pressure was determined by observing when lymph flow stopped under the cuff.Results: We measured the lymphatic occlusion pressure on 30 healthy volunteers (11 men and 19 women). Mean lymphatic occlusion pressure in the upper limb was 86 mm Hg (CI ±3.7 mm Hg, α = 0.5%). No significant differences were found between age groups (p = 0.18), gender (p = 0.12), or limb side (p = 0.85).Conclusions: NIRFLI, a transparent sphygmomanometer cuff and the “Fill and Flush” manual lymphatic drainage method were used to measure the lymphatic occlusion pressure in 30 healthy humans. That combination of these techniques allows the visualization of the lymph flow in real time, while ensuring the continuous filling of the lymph collectors during the measurement session, reducing false negative observations. The measured occlusion pressures are much higher than previously described in the medical literature.

Haddenham easywrap as part of self-management in lymphoedema and lipoedema: The patient perspective

“…Patients in two of the three case studies mentioned below have received individual mapping of the lymphatic drainage routes at LymphVision, the only private mapping clinic in the UK. This has allowed for the clinicians overseeing their care to teach modified simple lymphatic drainage, based on the 'fill and flush' technique (Belgrado, 2016), and can be seen to have enhanced their self-management technique. Ehmann et al (2016) suggest that velcro wrapping devices are becoming more popular in the treatment and management of lymphoedema and venous disease.…”

Lymphoedema management with the LymphFlow Advance pneumatic compression pump

“…Adams et al (2010) suggest the use of garments that treat the truncal area before treating the limb demonstrate an improved propulsion rate in lymph flow. Further consideration has been given to a theory proposed by Belgrado et al (2016) which states that knowing the occlusion pressure of the lymphatics will allow improved treatment between occluding and improving flow.…”

“…According to Segers et al (2002) pressures greater than 30 mmHg should not be used with a sequential compression cycle because of the interaction between each chamber, which causes an increase in pressure in the most distal chamber, leading to the pressure being greater than that shown on the control unit. In contrast Belgrado et al (2016) suggests that more pressure over the oedematous part of a limb will improve the transport of lymph to an area where it is free to drain The LymphFlow Advance has seven cycles ( Table 1) to enable the clinician to focus treatment on a particular area. Many of the pumps currently available only treat the whole limb, but the LymphFlow Advance will work intensively on the whole limb, or on the proximal or distal areas, or on the hand or foot.…”

“…In comparison to other pumps the LymphFlow Advance may be more effective as it uses a retrograde cycle in modes 1-4 while focussing on the specific area and then uses a sequential clearance. According to Belgrado et al (2016) the use of sequential pneumatic compression can…”

Protocol of a randomised controlled trial regarding the effectiveness of fluoroscopy-guided manual lymph drainage for the treatment of breast cancer-related lymphoedema (EFforT-BCRL trial)

“…The resorption of lymph capillaries has to be performed with the thumb (instead of with the hand in the traditional MLD, which gives a lower pressure). In addition, gliding (compared to no gliding) is hypothesised to be more effective to enhance lymphatic transport [17]. The physiological effect of one session of fluoroscopy-guided MLD was demonstrated in patients with BCRL [17,18].…”