The effectiveness of compression therapy in mild arm lymphedema

Background: Clinical experience indicates that edema often remain undiagnosed. The aim of this study was to examine how much time passes between important events in the patient journey and what predicts delayed consultation and diagnosis. Patients and methods: 65 patients with secondary arm lymphedema and 161 patients with primary or secondary leg lymphedema were interviewed. The following latency times were computed: the time between (1) first symptoms and first visit to physician; (2) visit of physician and diagnosis; (3) diagnosis and lymph drainage therapy; (4) diagnosis and compression therapy. Associations of latency times with patient and clinical characteristics were analysed using t tests and multivariate linear regression. Results: All arm edema patients had consulted a physician in the year after first symptoms at the latest, and everyone except two received the diagnosis in the following year at the latest. For secondary leg edema, the average latency until physician consultation was also short with 0.5 ± 1.8 years, and latency until diagnosis was 1.7 ± 3.8 years. In contrast, latencies in primary leg edema were significantly longer: The average time between first symptoms and physician consultation was 5.2 ± 11.0 years, and edema diagnosis was made after further 6.7 ± 11.4 years. On average, it took 13.5 years from first symptoms to lymph drainage therapy in these patients and 13.7 years until compression therapy. Predictors of late consultation and late diagnosis in primary leg edema were age < 40, positive family anamnesis, and female gender. Conclusions: Primary leg lymphedema is diagnosed late in many cases, especially in younger women.

Download Full-text

Compression therapy in lymphedema: Between past and recent scientific data

Phlebology The Journal of Venous Disease ◽

10.1177/0268355518824524 ◽

2019 ◽

Vol 34 (8) ◽

pp. 515-522 ◽

Cited By ~ 2

Author(s):

Giovanni Mosti ◽

Attilio Cavezzi

Keyword(s):

Clinical Trials ◽

High Pressure ◽

Lower Limb ◽

Compression Therapy ◽

Scientific Data ◽

Interface Pressure ◽

Compression Pressure ◽

High Stiffness ◽

Arm Lymphedema ◽

Strong Compression

Aim To extrapolate and discuss the scientific data on compression in lymphedema treatment, so to review old and innovative concepts about pressure, stiffness and other interplaying factors related to its efficacy and comfort. Material and methods Narrative review based on search in Medline/Google Scholar through key-words related to compression in lymphedema. Results Currently available literature lacks relevant details about data on protocol, devices, techniques, interface pressure, stiffness, as well as biases are represented by the different descriptions to present the outcomes. More recent evidence from adjustable wrap devices and elastic garments question the need for high pressure (especially for the upper limb) and stiffness in lymphedema treatment. Conclusions At present time a very strong compression pressure exerted by material with high stiffness seem to be questionable in lymphedema treatment. A low pressure provides the best outcomes in arm lymphedema, while a pressure in the range of 40–60 mm Hg seems to provide higher efficacy in lower limb lymphedema, provided it is maintained overtime. A high stiffness seems to be unnecessary to treat chronic edema. Future clinical trials, including proper description of treatment methodology and adequate investigating instrumental tools, are awaited to possibly corroborate the conclusive outcomes of our review.

Download Full-text

Liposuction Combined with Controlled Compression Therapy Reduces Arm Lymphedema More Effectively than Controlled Compression Therapy Alone

Plastic & Reconstructive Surgery ◽

10.1097/00006534-199809020-00021 ◽

1998 ◽

Vol 102 (4) ◽

pp. 1058-1067 ◽

Cited By ~ 99

Author(s):

Håkan Brorson ◽

Henry Svensson

Keyword(s):

Compression Therapy ◽

Arm Lymphedema

Download Full-text

Lymphedema and lipedema - an overview of conservative treatment

VASA ◽

10.1024/0301-1526/a000115 ◽

2011 ◽

Vol 40 (4) ◽

pp. 271-279 ◽

Cited By ~ 21

Author(s):

Wagner

Keyword(s):

Conservative Treatment ◽

General Practitioners ◽

Subcutaneous Tissue ◽

Compression Therapy ◽

Compression Stocking ◽

Lymph Drainage ◽

Intensive Phase ◽

Manual Lymph Drainage ◽

Causal Therapy

Lymphedema and lipedema are chronic progressive disorders for which no causal therapy exists so far. Many general practitioners will rarely see these disorders with the consequence that diagnosis is often delayed. The pathophysiological basis is edematization of the tissues. Lymphedema involves an impairment of lymph drainage with resultant fluid build-up. Lipedema arises from an orthostatic predisposition to edema in pathologically increased subcutaneous tissue. Treatment includes complex physical decongestion by manual lymph drainage and absolutely uncompromising compression therapy whether it is by bandage in the intensive phase to reduce edema or with a flat knit compression stocking to maintain volume.

Download Full-text

Primary varicose veins

Phlebologie ◽

10.1055/s-0037-1622305 ◽

2010 ◽

Vol 39 (03) ◽

pp. 133-137

Author(s):

H. Partsch

Keyword(s):

Varicose Veins ◽

Compression Therapy ◽

Daily Practice ◽

Clinical Severity ◽

Compression Stockings ◽

Primary Varicose Veins ◽

The Cost ◽

Convincing Data ◽

Long Term Studies

SummaryBackground: Compression stockings are widely used in patients with varicose veins. Methods: Based on published literature three main points are discussed: 1. the rationale of compression therapy in primary varicose veins, 2. the prescription of compression stockings in daily practice, 3. studies required in the future. Results: The main objective of prescribing compression stockings for patients with varicose veins is to improve subjective leg complaints and to prevent swelling after sitting and standing. No convincing data are available concerning prevention of progression or of complications. In daily practice varicose veins are the most common indication to prescribe compression stockings. The compliance depends on the severity of the disorder and is rather poor in less severe stages. Long-term studies are needed to proof the cost-effectiveness of compression stockings concerning subjective symptoms and objective signs of varicose veins adjusted to their clinical severity. Conclusion: Compression stockings in primary varicose veins are able to improve leg complaints and to prevent swelling.

Download Full-text

Therapeutic use of lowmolecular weight heparin for capillaritis alba

Phlebologie ◽

10.1055/s-0037-1622240 ◽

2008 ◽

Vol 37 (05) ◽

pp. 259-265 ◽

Cited By ~ 11

Author(s):

H. Kutzner ◽

G. Hesse

Keyword(s):

Case Studies ◽

Randomized Study ◽

Compression Therapy ◽

Venous Hypertension ◽

Therapeutic Use ◽

Prospective Randomized Study ◽

Anti Inflammatory ◽

Positive Effect ◽

Inflammatory Effect

SummaryThe reason of the so called ulcerated capillaritis alba or idiopathic atrophie blanche is vasculopathy caused by severe venous hypertension. Thrombosed and rarificated vessels worsen the oxygenation, increase permanent inflammation and impede the necessary compression therapy. The anti-inflammatory effects of heparin alleviate pain and being independent from the antithrombotic ones it needs much lower doses for treatment. This anti-inflammatory effect is now becoming more important in clinical phlebology. Case studies of more than 50 patients and one prospective randomized study of 87 patients clearly demonstrate the ameliorated healing of ulcerated atrophie blanche. In our office we could document this positive effect with 22 patients. We present the pathophysiology of low molecular heparins for ulcerated capillaritis alba and our own experiences with it.

Download Full-text