TY - JOUR

T1 - Microvascular filtration is increased in the forearms of patients with breast cancer-related lymphedema

AU - Jensen, Mads Radmer

AU - Simonsen, Lene

AU - Karlsmark, Tonny

AU - Bülow, Jens

PY - 2013

Y1 - 2013

N2 - Breast cancer-related lymphedema (BCRL) is a frequent and debilitating complication of breast cancer treatment. The pathophysiology is complex and remains poorly understood; however, data suggest that changes in the peripheral circulation may contribute to edema formation. In 13 volunteers with unilateral BCRL, the following aspects of upper extremity peripheral circulation were examined: muscle relative microvascular volume; capillary filtration coefficient; central and local sympathetic vascular reflexes; skin blood flow; and forearm blood flow. These were studied via real-time, contrast-enhanced ultrasound; venous occlusion strain-gauge plethysmography; lower-body negative pressure; noninvasive blood pressure measurements; and skin (99m)Tc-pertechnetate clearance technique. Measurements were performed bilaterally and simultaneously in the forearms, enabling use of the nonedematous forearm as a control. Capillary filtration coefficients were additionally measured in healthy, age-matched controls. The capillary filtration coefficient was 7.98 ± 2.52 μl·100 ml(-1)·mmHg(-1)·min(-1) (mean ± SD) in edematous forearms and 6.09 ± 1.83 μl·100ml·(-1)·mmHg(-1)·min(-1) in nonedematous forearms in the patient group (P <0.001). The capillary filtration coefficient was 3.32 ± 1.17 μl·100ml(-1)·mmHg(-1)·min(-1) in the forearms of healthy controls; significantly less than the both the edematous and nonedematous forearms of the patient group (P <0.001). No significant differences were found in muscle relative microvascular volume, forearm blood flow, skin blood flow, or central or local sympathetic vascular reflexes. Forearm microvascular filtration is increased in patients with BCRL, and more so in the edematous arm. The vascular sympathetic control mechanisms seem to be preserved. We propose that the increased capillary permeability may be due to low-grade inflammation promoted by reduced clearance of inflammatory mediators.

AB - Breast cancer-related lymphedema (BCRL) is a frequent and debilitating complication of breast cancer treatment. The pathophysiology is complex and remains poorly understood; however, data suggest that changes in the peripheral circulation may contribute to edema formation. In 13 volunteers with unilateral BCRL, the following aspects of upper extremity peripheral circulation were examined: muscle relative microvascular volume; capillary filtration coefficient; central and local sympathetic vascular reflexes; skin blood flow; and forearm blood flow. These were studied via real-time, contrast-enhanced ultrasound; venous occlusion strain-gauge plethysmography; lower-body negative pressure; noninvasive blood pressure measurements; and skin (99m)Tc-pertechnetate clearance technique. Measurements were performed bilaterally and simultaneously in the forearms, enabling use of the nonedematous forearm as a control. Capillary filtration coefficients were additionally measured in healthy, age-matched controls. The capillary filtration coefficient was 7.98 ± 2.52 μl·100 ml(-1)·mmHg(-1)·min(-1) (mean ± SD) in edematous forearms and 6.09 ± 1.83 μl·100ml·(-1)·mmHg(-1)·min(-1) in nonedematous forearms in the patient group (P <0.001). The capillary filtration coefficient was 3.32 ± 1.17 μl·100ml(-1)·mmHg(-1)·min(-1) in the forearms of healthy controls; significantly less than the both the edematous and nonedematous forearms of the patient group (P <0.001). No significant differences were found in muscle relative microvascular volume, forearm blood flow, skin blood flow, or central or local sympathetic vascular reflexes. Forearm microvascular filtration is increased in patients with BCRL, and more so in the edematous arm. The vascular sympathetic control mechanisms seem to be preserved. We propose that the increased capillary permeability may be due to low-grade inflammation promoted by reduced clearance of inflammatory mediators.

KW - Blood Pressure

KW - Breast Neoplasms

KW - Capillaries

KW - Capillary Permeability

KW - Female

KW - Forearm

KW - Humans

KW - Lymphedema

KW - Microcirculation

KW - Middle Aged

KW - Muscles

KW - Reflex

KW - Regional Blood Flow

KW - Skin

U2 - 10.1152/japplphysiol.01116.2012

DO - 10.1152/japplphysiol.01116.2012

M3 - Journal article

C2 - 23123353

VL - 114

SP - 19

EP - 27

JO - Journal of Applied Physiology

JF - Journal of Applied Physiology

SN - 8750-7587

IS - 1

ER -