Microvascular filtration is increased in the forearms of patients with breast cancer-related lymphedema
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Microvascular filtration is increased in the forearms of patients with breast cancer-related lymphedema. / Jensen, Mads Radmer; Simonsen, Lene; Karlsmark, Tonny; Bülow, Jens.
In: Journal of Applied Physiology, Vol. 114, No. 1, 2013, p. 19-27.Research output: Contribution to journal › Journal article › Research › peer-review
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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 -
ID: 48493123