Can a lymphedema compression device be used in cases of lower extremities Peripheral Vascular Disease (PVD)?

From the Guidelines

Lymphedema compression devices should not be used in cases of lower extremity Peripheral Vascular Disease (PVD) without careful medical evaluation and supervision, as compression therapy can potentially reduce arterial blood flow and worsen tissue perfusion. The primary concern is that patients with PVD already have compromised circulation, and adding compression could further compromise arterial circulation.

Key Considerations

• Before considering compression therapy, patients with PVD should undergo vascular assessment, including measurement of the Ankle-Brachial Index (ABI) 1.
• An ABI below 0.8 typically indicates significant arterial disease, making standard compression contraindicated 1.
• In cases where compression is deemed necessary for coexisting lymphedema, modified approaches may be considered, such as using reduced compression pressures (typically below 30 mmHg), as evidenced by studies showing that for ankle-brachial indices between 0.9 and 0.6, reduced compression to 20 to 30 mm Hg is successful and safe for venous leg ulcers (VLU) healing 1.
• Any compression therapy for patients with PVD should include regular monitoring for signs of tissue ischemia, including increased pain, numbness, tingling, color changes, or coldness in the extremity.

Evidence-Based Recommendations

• The use of compression therapy in patients with PVD requires careful consideration of the potential risks and benefits, and should be individualized based on the patient's specific condition and needs 1.
• Collaboration between vascular and lymphedema specialists is often necessary to balance the need to manage lymphedema fluid with the risk of further compromising arterial circulation.
• Regular monitoring and adjustment of compression therapy as needed is crucial to minimize the risk of adverse effects and optimize outcomes for patients with PVD and lymphedema.

From the Research

Lymphedema Compression Device Use in Lower Extremities Peripheral Vascular Disease

• The use of lymphedema compression devices in cases of lower extremities Peripheral Vascular Disease (PVD) requires careful consideration due to potential contraindications and complications.
• According to 2, compression garments are contraindicated and not tolerated by patients with extensive peripheral arterial disease, suggesting that alternative treatments such as simple lymphatic drainage may be safer options.
• However, studies such as 3 and 4 demonstrate the effectiveness of compression devices, including adjustable compression wraps and sequential pneumatic compression, in reducing lymphedema in the lower extremities.
• The study 3 highlights the importance of finding the right compression therapy, as one class of compression garment may not always be sufficient, and the combination of two garments or the use of non-elastic leg binders may be necessary.
• Additionally, 5 shows that adding pneumatic compression therapy to standard treatment for lower extremity lymphedema can increase compliance and decrease infection rates, which may be beneficial for patients with PVD.
• It is essential to weigh the potential benefits and risks of using lymphedema compression devices in patients with lower extremities PVD, considering individual patient factors and comorbidities, as noted in 6.

Key Considerations

• Patient tolerance and potential contraindications, such as extensive peripheral arterial disease, must be carefully evaluated before using lymphedema compression devices.
• The selection of the appropriate compression device and therapy regimen is crucial to achieve optimal outcomes and minimize complications.
• Further research and individualized assessment are necessary to determine the safest and most effective treatment approach for patients with lower extremities PVD and lymphedema.