February 2019

Compression in Lymphedema

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In a narrative review of old and innovative concepts concerning pressure and stiffness in lymphedema therapy, the authors of a study just published in Phlebology found that the current literature does not appear to be in sync with the array of options available today.

Specifically, the authors report new evidence, including:

  • “As for lower limb compression, when treating venous edema and dependency syndrome (soft, pitting edema that disappear or reduces in supine position), we were able to show that a stocking exerting around 20 mm Hg pressure at the ankle is almost as effective as an inelastic bandage exerting a pressure higher than 60 mm Hg. In our experience, an optimal compression pressure in leg venous edema was around
    40 mm Hg at the ankle, especially when maintained over time by means of an adjustable compression device. Also in lymphedema, similar outcomes comparing adjustable compression wraps (ACW) and inelastic bandages were shown. It was demonstrated that ACW, even when applied with the same pressure of about 50 mm Hg as inelastic bandages, are more effective in leg volume reduction due to the device self-readjustment by patients leading to a better pressure maintenance overtime.
  • “In leg lymphedema experimental studies (performed through intra-lymphatic pressure and flow measurement), the gradual increase of foot-applied compression up to 40 mm Hg, showed an increasing intra-lymphatic pressure while evoking spontaneous lymph vessel contractions. Higher pressures did not result in any additional beneficial effect.
  • “In agreement with literature data, a pressure of about 40-50 mm Hg has been established as a standard value in increasing the lymph drainage in the lower limb: higher pressure is not necessary and potentially counterproductive.
  • “Despite suggestions regarding compression with high stiffness to treat lymphedema, our group showed that elastic stockings exerting
    23-32 mm Hg, as well as elastic kits exerting about 40 mm Hg, were almost as effective as inelastic bandages in reducing the lower limb edema. The average SSI [static stiffness index] value of these compression devices was 3 both for elastic stockings and elastic kits. Similarly, ACW SSI index value was 7 in our study on venous edema and 2 in the lower limb lymphedema study, both indicating a low stiffness of the material. In contrast, inelastic material had always an SSI value higher than 10 and also above 20, but this high stiffness did not result in a more effective edema treatment. It is necessary to underline that both elastic stockings and ACW maintained their pressure range over time very effectively in all these studies, whereas inelastic bandages showed a significant pressure loss already after 24 h. Regarding the comfort of compression devices, inelastic bandages are always reported as comfortable in the examined studies. Both elastic stockings and elastic kits were well tolerated during the day and not well tolerated only overnight. ACWs applied in lymphedema treatment were reported to have a good comfort without any complaint from the patients and without significant differences compared to inelastic bandages.”

The authors also point out that other factors (e.g., patient’s mobility, abnormally shaped limbs, coexisting arterial disease) need to play a role in the process for deciding which compression material should be used to treat lymphedema; in patients with arterial disease, the compression pressure must be reduced and should not exceed 40 mm Hg. They conclude that maintaining moderate or strong pressure over time should be pursued as the treatment for extremity lymphedema.

World Lymphedema Day

• The World Health Organization estimates that more than 250 million people worldwide have lymphedema.

• Lymphedema affects approximately 15% of cancer survivors and as many as 30% of all people treated for breast cancer.

The annual World Lymphedema Day (March 6) focuses on a worldwide effort to ask the World Health Organization to make “Lymphedema: Awareness & Cures” its 2020 World Health Day Campaign. A petition started on www.change.org has already garnered more than 2,000 signatures and grows daily.

The mission of the Lymphatic Education & Research Network is to fight lymphatic disease and lymphedema through education, research and advocacy. The LE&RN provides valuable educational resources for patients, and fosters and supports research that can deepen the medical community’s understanding of the lymphatic system. For more information about lymphatic disease and the LE&RN, visit https://lymphaticnetwork.org.

Excerpted with permission from: Mosti G, Cavezzi A. Compression therapy in lymphedema: between past and recent scientific data. Phlebology. Jan 9, 2019:268355518824524. 

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