The Effectiveness of Intermittent Pneumatic Compression in Therapy of Lymphedema of Lower Limbs: Methods of Evaluation and Results
Marzanna T. Zaleska, MD1,2 and Waldemar L. Olszewski, MD, PhD2. Lymphatic Research Biology 2018. Lymphatic Research and Biology 2018
Background: Evaluation of intermittent pneumatic compression (IPC) in lymphedema is classically based on measurements of circumferences and volume of the edematous limb. However, although important, it provides only a general information without insight into what proceeds under the skin with respect to hydromechanical and structural changes.
Aim and Methods: We present the multimodal evaluation of the effectiveness of IPC device in limb edema by measuring tissue stiffness, ﬂuid pressure, and ﬂow volume, and lymphoscintigraphic and near-infrared ﬂuorescence (NIRF) indocyanine green (ICG) lymphography imaging of edema ﬂuid movement, before and after one 45–60 minute compression cycle in over 50 patients with lymphedema stage II and III.
Results: (1) Tissue ﬂuid pressures were lower than those applied by IPC device. (2) The higher the applied compression force, the larger the ﬂow volume. (3) Skin stiffness (superﬁcial tonometry) decreased mainly in the calf, whereas, subcutaneous tissue (deep tonometry) was observed at all limb levels. (4) Skin water concentration (dielectric constant) was only insigniﬁcantly decreased, but subcutaneous extracellular water (bioimpedance Ldex index, ﬂuid movement force test) was effectively moved away to limb proximal regions. (5) Imaging tissue (edema) ﬂuid ﬂow pathways on lymphoscintigram and real-time ﬂow on NIRF ICG video could be observed and were evaluated semi quantitatively.
Conclusions: Adjustment of compression parameters to tissue stiffness, ﬂuid accumulation volumes, and ﬂuid movement ability (hydraulic conductivity of tissues) at various limb levels is indispensable for effective therapy. Redesigning of compression devices will be needed to enable applying differentiated compression pressures and prolonged timings at various limb levels.