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Role of the lymphatic vasculature in cardiovascular medicine
  1. Niklas Telinius1,
  2. Vibeke Elisabeth Hjortdal2,3
  1. 1Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
  2. 2Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
  3. 3Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen, Denmark
  1. Correspondence to Vibeke Elisabeth Hjortdal, Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen, Denmark; vhjortdal{at}


The lymphatic vasculature has traditionally been considered important for removal of excessive fluid from the interstitial space, absorption of fat from the intestine and the immune system. Advances in molecular medicine and imaging have provided us with new tools to study the lymphatics. This has revealed that the vessels are actively involved in regulation of immune cell trafficking and inflammation. We now know much about how new lymphatic vessels are created (lymphangiogenesis) and that this is important in, for example, wound healing and tissue repair. The best characterised pathway for lymphangiogenesis is the vascular endothelial growth factor C (VEGF-C)/VEGFR3 pathway. Over recent years, there has been an increasing interest in the role of the lymphatics in cardiovascular medicine. Preclinical studies have shown that lymphangiogenesis and immune cell trafficking play a role in cardiovascular conditions such as atherosclerosis, recovery after myocardial infarction and rejection of cardiac allografts. Targeting the VEGF-C/VEGFR3 pathway can be beneficial in these conditions. The clinical spectrum of lymphatic abnormalities and lymphoedema is wide and overlaps with congenital heart disease. Important long-term complications to the Fontan circulation involves the lymphatics. New and improved imaging modalities has improved our understanding and management of these patients. Lymphatic leaks and flow abnormalities can be successfully treated, minimally invasively, with percutaneous embolisation. Future research will prove if the preclinical findings that point to a role of the lymphatics in several cardiovascular conditions will result in new treatment options.

  • lymphatic vessels
  • edema
  • lymphedema
  • lymphangiogenesis
  • heart diseases

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  • Correction notice Since this article was first published online, figure 1 and 6 have been replaced. Figure 1 is now higher resolution and figure 6 has replaced section B of the artwork.

  • Contributors Both authors researched for data and wrote the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; externally peer reviewed.

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