METHOD OF LIFE-TIME STUDY OF ANATOMICAL AND PHYSIOLOGICAL FEATURES OF SUPERFICIAL LYMPHATIC VESSELS OF LOWER EXTREMITIES IN NORM AND IN CHRONIC VENOUS INSUFFICIENCY Russian patent published in 2019 - IPC A61B5/215 A61K49/00 A61P43/00 

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to angiology, and can be used for lifetime assessment of anatomical and physiological features of surface lymphatic vessels of lower extremities in norm and in chronic venous insufficiency. To assess the anatomical and physiological features of the surface lymphatic vessels of the lower extremities, fluorescent lymphography is used with subcutaneous injection of fluorescein into the extremity zone and exposure to the region of introduction with a light source with wavelength of 480 nm. 15 minutes after administration of fluorescein, vessels are visualized to observe yellow-green fluorescence. According to fluorescence, the medial, lateral and posterior groups of the limb vessels of the limb are isolated, the number and direction of which are used to assess the norm or chronic venous insufficiency. Prior to the procedure, fluorescein is dissolved in physiologic saline. Obtained 1 % solution is injected subcutaneously into the area of the first and second interlocked spaces, and the area of the right and left ankle is 2 ml each. Regions of introduction are documented by a digital camera at intervals. In each time interval increase in length of stained vessels is considered to calculate rate of lymphatic drain by formula: V=S/T, where S – length of colored vessel, T – time elapsed after drug administration. Localization, number, rectilinearity and diameter of lymphatic vessels, as well as direction of lymph current are evaluated. Patient's condition is evaluated proceeding from the following conditions. In the healthy individuals with 0-1 class of varicosis by CEAP for first 25 seconds after the fluorescein solution injection, the place of introduction retains the round shape elongated in the direction of injection. In next 60 seconds, the shape is elongated in the proximal direction. Preparation is delivered to the lymph capillary at 30th second. There is a projection in upper part of the spot. In 20 seconds said projection is clearly visible. In medial part of shin, preparation when examining medial commutator in healthy person appears in 5.3±1.1 min, lateral – 4.6±0.8 min later. Antegrade lymph rate by surface lymphatic vessels is 11.3±1.7 cm/min. Increased diameter and tortuosity of the lymphatic vessels in the shin area are noted in the patients with the initial stage of 2-3 class of varicosis by CEAP. Superficial lymphatic vessels of the lower extremities consist of diverting commissural lymphatic vessels, and in the shin area three directions of surface collector lymphatic vessels guided to the hip are preserved. Number of collector lymphatic vessels of the medial group is 6 lymphatic vessels, the lateral group – 5 vessels, the rear group of headers consists of 2 vessels. In the projection of the knee joint lymphatic shin collectors are merged into 3 vessels and directed along an anteromedial surface. Antegrade rate of lymph on surface lymphatic vessels makes – 6.4±0.8 cm/min. In patients with 4th clinical class according to CEAP, the expansion or constriction, as well as tortuosity of the lymphatic vessels on the foot, absence of contrasting in the zone of trophic changes in the lower and middle thirds of the shin. When fluororate is introduced into an ankle, the lymphatic vessels are colored retrograde. Antegrade rate of lymph on surface lymphatic vessels on back of foot is 1.3±0.2 cm/min. Established retrograde current of fluorenate from the ankles passes at rate of 2.7±0.9 cm/min. Patients with 5-6 clinical class of CEAP are diagnosed with constriction and tortuosity of lymphatic vessels on the foot, in the shin area, where there are indurative skin changes. Contrasting of lymphatic vessels is not observed. When fluororate is administered into the ankle region, the coloring takes place in the retrograde direction at rate of 1.5±0.4 cm/min.

EFFECT: method provides a quality lifetime study of anatomy and assessment of functional state of surface lymphatic vessels of lower extremities, both in norm, and in chronic venous insufficiency of lower extremities due to fluorescent lymphography.

1 cl, 6 dwg, 1 tbl