The pathophysiology of lymphedema.
BACKGROUND: All edemas result from an imbalance between capillary filtration and tissue (lymph) drainage. This basic approach was adopted to investigate mechanisms for chronic arm edema following breast carcinoma treatment. METHODS: A review of causes of lymphedema is presented plus the traditional pathophysiology of breast carcinoma related lymphedema (postmastectomy edema; PME). A summary of recent research that explored capillary filtration as a surrogate for lymph flow in the steady state is presented. RESULTS: A reduced interstitial protein concentration (relative to plasma) argues against lymphatic obstruction. Evidence exists that total arm blood flow (in some patients) and vascular bed size are increased in PME. CONCLUSIONS: The primary insult to the axillary lymphatic system by surgery and radiotherapy presumably is the root cause of PME; however, there is strong evidence to suggest that hemodynamic factors are contributory to the chronic swelling.[1]References
- The pathophysiology of lymphedema. Mortimer, P.S. Cancer (1998) [Pubmed]
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