Peripheral Vascular Disease (PVD) of the lower extremities is a common chronic condition in the growing population >50 years of age and typically progresses to ulceration for which costly and often ineffective treatments exist. While PVD is typically associated with disease of the artery and veins, preliminary studies using near-infrared fluorescence (NIRF) imaging indicates lymphatic pumping is impaired at early stages. In this application, we seek to determine whether an impaired lymphatic pump is associated with PVD, potentially enabling the identification of new, more effective therapeutic strategies.
Peripheral Vascular Disease (PVD) impacts arteries and veins of the lower extremities and is the leading cause of disability in people older than 50 years of age. As survivorship from cardiovascular disease increases and as the population continues to age, PVD incidence will continue to rise. Emerging evidence suggests that the lymphatics play an important role in the early pathogenesis and progression of PVD. Yet today, surgical treatments focus upon re-vascularizing the blood vasculature. If lymphatic insufficiency were found to be associated with pathogenesis and progression of PVD, then more durable outcomes may be achieved by developing new treatments directed to the lymphatic vasculature. Therapeutic strategies to modulate the immune-lymphatic system could be developed and implemented to improve effectiveness of managing PVD in the increasing population of the world's aged. Currently, there are limited methods for assessing the role of dynamic, peripheral lymphatic function in patients with PVD. In this exploratory/developmental bioengineering application, we seek to build upon preliminary data generated with investigational near-infrared fluorescence lymphatic imaging (NIRFLI) that shows lymphatic abnormalities occur in PVD patients with specific aims to: (1) Modify investigational NIRFLI techniques to quantitatively assess lymphatic anatomy and function in the lower extremities of PVD patients; and (2) Systematically assess bilateral lymphatic function in 40 patients with early or mild to moderate PVD in the lower extremities of patients that are stationary and/or walking on a treadmill in an outpatient vascular clinic. Our hypothesis is that lymphatic insufficiency is an important component of progressing PVD. By demonstrating the potential role of lymphatic dysfunction in PVD, we believe a paradigm-shift in management of PVD could result in the development of new therapeutic strategies directed to the lymphatic vasculature and improve outcomes in the world's growing, aged population.
| O'Donnell Jr, Thomas F; Rasmussen, John C; Sevick-Muraca, Eva M (2017) New diagnostic modalities in the evaluation of lymphedema. J Vasc Surg Venous Lymphat Disord 5:261-273 |
