Abstract
Previous studies have shown cost effectiveness and quality-of-life benefit of pneumatic compression therapy (PCT) for lymphedema. Insurers, such as the Centers for Medicare/Medicaid (CMS), however, desire visual proof that PCT moves lymph. Near-infrared fluorescence lymphatic imaging (NIRFLI) was used to visualize lymphatic anatomy and function in four subjects with primary and cancer treatment-related lymphedema (LE) of the lower extremities before, during, and after pneumatic compression therapy (PCT). Optically transparent and windowed PCT garments allowed visualization of lymph movement during single, one-hour PCT treatment sessions. Visualization revealed significant extravascular and lymphatic vascular movement of intradermally injected dye in all subjects. In one subject with sufficient patent lymphatic vessels to allow quantification of lymph pumping velocities and frequencies, these values were significantly increased during and after PCT as compared to pre-treatment values. Lymphatic contractile activity in patent lymphatic vessels occurred in concert with the sequential cycling of PCT. Direct visualization revealed increased lymphatic function, during and after PCT therapy, in all lymphedema-affected extremities. Further studies are warranted to assess the effects of PCT pressure and sequences on lymph uptake and movement.
Highlights
Lymphedema (LE) is an accumulation of excessive lymph °uid in the subcutaneous tissues, due to inadequate transport capacity of the lymphatic system
The inadequate transport can result from impairment of the lymphatic vessels, as occurs in up to 30% of U.S cancer survivors, due to lymph vessel disruption,[1,2,3,4] from lymph vessel malformations, as in genetically associated LE,[5,6] from chronic venous insu±ciency,[7] and other causes
Lymphaticovenous anastomoses and lymph node transplant surgeries have been performed on selected LE patients, and have demonstrated decreased cellulitis incidence and limb swelling in many cases.[9,10,11,12,13,14]
Summary
Lymphedema (LE) is an accumulation of excessive lymph °uid in the subcutaneous tissues, due to inadequate transport capacity of the lymphatic system. The inadequate transport can result from impairment of the lymphatic vessels, as occurs in up to 30% of U.S cancer survivors, due to lymph vessel disruption,[1,2,3,4] from lymph vessel malformations, as in genetically associated (primary) LE,[5,6] from chronic venous insu±ciency,[7] and other causes. Lymphaticovenous anastomoses and lymph node transplant surgeries have been performed on selected LE patients, and have demonstrated decreased cellulitis incidence and limb swelling in many cases.[9,10,11,12,13,14] Compression garment use after the surgeries is still required to maintain limb volume reductions in most cases to prevent further lymph and subcutaneous adipose accumulation. Surgical treatment is indicated for patients who do not improve with conservative measures, or for patients in whom the extremity is so large that it impairs daily activities and prevents successful conservative management,[9] but US medical insurers do not routinely cover the surgeries
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