[Influence of intermittent pneumatic compression on microvasculature condition in lymphedema. Prospective randomized clinical trial].

Abstract

Lymphedema is a chronic disabling disease that affects 250 million people worldwide. To this date, it has been proven that treatment of this category of patients should be truly integrated - combining surgical, therapeutic methods and recovery procedures.

Objective: To study the influence of intermittent pneumatic compression (IPC) on microvasculature in patients with lymphedema of the lower extremities.

Material and methods: Prospective randomized clinical trial included the observation of 60 patients with lower extremities' lymphedema of stages I-III, divided into 2 groups. The 1st group consisted of 30 patients who received IPC in addition to the baseline therapy (lymphotonic agents for 3 weeks and elastic compression using therapeutic garment of the 3^rd compression class for 1 month); the 2^nd group included 30 patients who received only baseline therapy. Laser doppler flowmetry (LDF) was applied to study microhemodynamics.

Results: Most patients complained of swelling and heaviness sensation in the affected extremity, increased fatigue at admission. The presence of dense, painless swellings in the foot arch and tibia was revealed during physical examination. The difference in circumference of lower third of the tibia with a healthy extremity was equal 4.1±1.73 cm on average. The data obtained from LDF indicated that patients with lymphedema had impaired endothelial function, arterioles spasticity and decreased level of capillary perfusion. The 1st group patients had improvement of all LDF indicators after the treatment course. The 2^nd group patients had a positive dynamics only in two LDF indicators.

Conclusion: Patients with lymphedema of the lower extremities had changes in all microvasculature components according to the LDF. The inclusion of IPC in a comprehensive rehabilitation program for this category of patients led to the elimination of impaired endothelial function that contributed to vasodilatation of arterioles and microhemodynamics improvement in general. Regression of the disease's clinical symptoms was found in a greater degree in patients receiving IPC compared to control group.