Abstract
Abstract
Background
Intact lymphatic vessels maintain strict blood-lymphatic segregation. While pathological blood-lymphatic mixing occurs in genetic animal models, spontaneous intralymphatic blood filling has not been clinically documented.
Methods
A 55-year-old woman with secondary upper-extremity lymphedema following mastectomy presented with abnormal blood flow signals within lymphatic lumina on preoperative high-frequency ultrasound. She had chronic aspirin use and developed acute severe hypertension (220/100 mmHg) with extensive cutaneous ecchymosis preoperatively. Six lymphaticovenous anastomoses were performed under microscopy.
Results
Intraoperative visualization confirmed blood-filled lymphatic vessels, corroborating ultrasound findings. At 3-month follow-up, the corrected edema reduction rate reached 33.68%, with clinically meaningful improvements in body image, symptom, and mood subdomains of the LYMQOL-Arm scale.
Conclusions
This represents the first clinical evidence of intralymphatic blood filling. We hypothesize acute hypertension exacerbated venous reflux through latent lymphovenous communications, while aspirin disrupted physiological platelet-mediated blood-lymphatic segregation. LVA remains feasible when intraoperative assessment confirms higher intralymphatic pressure and favorable flow directionality, though single-case limitations apply.