Chronic edema of the lower extremities: International consensus recommendations for compression therapy clinical research trials

Breast Care Department, Walter Reed National Military Medical Center, Bethesda, MD, USA.
International angiology: a journal of the International Union of Angiology (Impact Factor: 0.83). 08/2012; 31(4):316-29.
Source: PubMed


Chronic edema is a multifactorial condition affecting patients with various diseases. Although the pathophysiology of edema varies, compression therapy is a basic tenant of treatment, vital to reducing swelling. Clinical trials are disparate or lacking regarding specific protocols and application recommendations for compression materials and methodology to enable optimal efficacy. Compression therapy is a basic treatment modality for chronic leg edema; however, the evidence base for the optimal application, duration and intensity of compression therapy is lacking. The aim of this document was to present the proceedings of a day-long international expert consensus group meeting that examined the current state of the science for the use of compression therapy in chronic edema. An expert consensus group met in Brighton, UK, in March 2010 to examine the current state of the science for compression therapy in chronic edema of the lower extremities. Panel discussions and open space discussions examined the current literature, clinical practice patterns, common materials and emerging technologies for the management of chronic edema. This document outlines a proposed clinical research agenda focusing on compression therapy in chronic edema. Future trials comparing different compression devices, materials, pressures and parameters for application are needed to enhance the evidence base for optimal chronic oedema management. Important outcomes measures and methods of pressure and oedema quantification are outlined. Future trials are encouraged to optimize compression therapy in chronic edema of the lower extremities.

Download full-text


Available from: André Cornu-Thénard,
  • Source
    • "It consists of skin care, exercises, compression with an inelastic garment and manual lymphatic drainage when needed. Since the type of edema is usually multifactorial including lymphedema as well as venous stasis, the focus of the treatment has to be based on compression therapy (multilayer bandaging and garment wear) and exercise therapy [20] [21]. This conservative approach can be combined with treatment with a loop diuretic such as furosemide. "

    Gynecologic Oncology 05/2013; 130(3). DOI:10.1016/j.ygyno.2013.05.023 · 3.77 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The optimal pressure to reduce chronic extremity swelling is still a matter of debate. The aim of this paper was to measure volume reduction of a swollen extremity depending on the amount of pressure exerted by compression stockings and inelastic bandages. Thirty-six patients with unilateral breast cancer related arm lymphedema were investigated in a lymph clinic in the Netherlands, 42 legs with chronic edema of the lower extremities were examined in a phlebological centre in Italy. The arm-patients were randomized to receive inelastic arm bandages with a pressure between 20-30 mmHg or 44-68 mmHg. The leg patients were either treated with compression stockings (23-32 mmHg) or with inelastic bandages (pressure 53-88 mmHg). Water-displacement volumetry and measurement of leg circumference was performed before and after compression. In the arm-patients low pressure after 2 hours achieved a higher degree of volume reduction (-2.3%, 95% CI 1.0-3.6) than high pressure (-1.5%, 95% CI 0.2-2.8) (n.s.). In patients with leg edema compression stockings in the range between 20 and 40 mmHg showed a positive correlation between exerted pressure and volume reduction, bandages applied with an initial resting pressure of more than 60 mm Hg resulted in a decreasing volume reduction. There is obviously an upper limit beyond which further increase of compression pressure seems counterproductive. For inelastic bandages this upper limit is around 30 Hg on the upper and around 50-60 mmHg on the lower extremity.
    International angiology: a journal of the International Union of Angiology 12/2011; 30(6):527-33. · 0.83 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The International Compression Club (ICC) is a partnership between academics, clinicians and industry focused upon understanding the role of compression in the management of different clinical conditions. The ICC meet regularly and from these meetings have produced a series of eight consensus publications upon topics ranging from evidence-based compression to compression trials for arm lymphoedema. All of the current consensus documents can be accessed upon the ICC website ( In May 2011, the ICC met in Brussels during the European Wound Management Association (EWMA) annual conference. With almost 50 members in attendance the day-long ICC meeting challenged a series of dogma's and myths that exist when considering compression therapies. In preparation for the discussion of beliefs surrounding compression a Forum was established on the ICC website where presenters were able to display a summary of their thoughts upon each dogma to be discussed during the meeting. Members of the ICC could then provide comments upon each topic so widening the discussion to the entire membership of the ICC rather than simply those who were attending the EWMA conference! This article presents an extended report of the issues that were discussed, with each dogma covered in a separate section. The ICC discussed 12 'dogmas' with areas 1 through 7 dedicated to materials and application techniques used to apply compression with the remaining topics (8 through 12) related to the indications for using compression.
    International Wound Journal 06/2012; 10(5). DOI:10.1111/j.1742-481X.2012.01009.x · 2.15 Impact Factor
Show more