Lymph channels in the leg

Abstract

Lymphedema is one of the complications of varicose vein therapy. Pittaluga and Chastanet found lymphedema in only 0.25 % after surgical intervention. Flessenkämper and colleagues were able to show that this occurs in 2.8 % (high ligature and stripping) to 9.2 % (endovenous laser ablation), depending on the therapy method used. One of the possible reasons for this lymphedema could be a direct damage of the (sub-)inguinal lymphatic vessels. In an anatomical study, a fine “VSM removal scar” was found on the medial left thigh, probably after a crossectomy. All collectors that passed through the scar obliterated at the scar while moving to the large inferolateral lymph nodes. Laterally to the scar they had a normal appearance and could be recannulated. Up to now, (anatomical) research has paid little attention to this aspect; however, it has been shown that several lymph vessels run underneath the saphenous fascia, parallel to the great saphenous vein.

In the exploratory anatomical study presented here, twenty lower extremities of ten individuals were used.

The right-hand specimens were meticulously dissected in layers of the subinguinal region as far as possible. The left specimens were frozen and cut half longitudinally and half transversely. The resulting sections were examined for the exact course of the fascia lata, the cribrous fascia and the saphenous fascia and the exact location of the lymph nodes and pathways was determined.

Extensive intervention on the proximal saphenous vein, whether in classical crossectomy or in various endovenous procedures, the respective agent of which may extend beyond the venous wall itself, can lead to at least partial damage to accompanying lymph vessels. In most cases, the total transport capacity of the superficial lymph channels of the leg is not reduced below the lymphatic load; however, a pre-existing impairment or a later occurring further reduction of the total transport capacity can result in lymphedema.

Key words

lymphology - phlebology

Schlüsselwörter

Lymphologie - Phlebologie

Publication History

Article published online:
03 November 2020

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