[Scintigraphic assessment of abnormal lymphatic function in edema of the lower limbs in patients with venous leg ulcers].

Venous ulceration of the legs is a complication of chronic venous insufficiency. Its pathogenesis together with the coexisting participation of insufficiency of the lymphatic system has not been fully explained. Clinical observations have shown that some of afflicted patients develop marked edema of the ulcerated extremity. The purpose of the studies performed with the use of lymphoscintigraphic radioisotopic method was the evaluation of the role of abnormal lymphatic function in the development of edema of the extremity.

METHODS

The scintigraphic investigation with the use of human albumin labeled with 99mTc (Nanocoll) was performed in 43 patients with venous ulceration of one lower limb. A passage time of the colloid from the foot to the inguinal lymph nodes and its accumulation in the lymphatic system were evaluated.

RESULTS

The mean passage time of the radiopharmaceutic from the foot to the groin of the ulcerated extremities was statistically significantly longer than that on the opposite side (20 min, SD 15 min 30 s vs. 12 min 30 s, SD 12 min 30 s; p < 0.001). The signs of obstruction of the lymphatic vessels were revealed in 16 out of 43 ulcerated extremities (37%) and in 4 out of 43 extremities without ulceration (9%; p < 0.005).

CONCLUSIONS

1. Lymphoscintigraphy has shown abnormal lymphatic function in patients with ulceration and edema of lower limb. 2. In the group of patient with venous lower leg ulcers a longer passage time of the lymph in the afflicted extremity was revealed. 3. In over 1/3 of the examined lower extremities with venous ulceration the signs of obstruction of the lymphatic vessels were found.