[S1 guideline on intermittent pneumatic compression (IPC)]. / S1-Leitlinie Intermittierende Pneumatische Kompression (IPK, AIK).

Under the direction of the German Society of Phlebology (Deutsche Gesellschaft für Phlebologie) and in cooperation with other specialist associations, the S1 guideline on intermittent pneumatic compression (IPC) was adopted in January 2018. It replaces the previous guideline from March 2005. The aim of the guideline is to optimize the indication and therapeutic use of IPC in vascular diseases and edema. An extensive literature search of MEDLINE, existing guidelines, and work relevant to the topic was performed. In view of the often methodologically weak study quality with often small numbers of cases and heterogeneous treatment protocols, recommendations can often only be derived from the available data using good clinical practice/expert consensus. Intermittent pneumatic compression is used for thromboembolism prophylaxis, decongestive therapy for edema, and to positively influence arterial and venous circulation to improve clinical symptoms and accelerate ulcer healing in both the outpatient and inpatient care setting. The therapy regimens and devices used depend on the indication and target location. They can be used as outpatient and inpatient devices as well as at home for long-term indications. A target indication is thrombosis prophylaxis. IPC should be used in severe chronic venous insufficiency (stages C4b to C6), in extremity lymphedema as an add-on therapy and in peripheral arterial occlusive disease (PAOD) with stable intermittent claudication or critical ischemia. IPC can be used in post-traumatic edema, therapy-resistant venous edema, lipedema and hemiplegia with sensory deficits and edema. Absolute and relative contraindications to IPC must be taken into account and risks considered and avoided as far as possible. Adverse events are extremely rare if IPC is used correctly. If the indication and application are correct-also as an add-on therapy-it is a safe and effective treatment method, especially for the treatment of the described vascular diseases and edema as well as thrombosis prophylaxis.

Clinical trials needed to evaluate compression therapy in breast cancer related lymphedema (BCRL). Proposals from an expert group.

AIM: A mainstay of lymphedema management involves the use of compression therapy. Compression therapy application is variable at different levels of disease severity. Evidence is scant to direct clinicians in best practice regarding compression therapy use. Further, compression clinical trials are fragmented and poorly extrapolable to the greater population. An ideal construct for conducting clinical trials in regards to compression therapy will promote parallel global initiatives based on a standard research agenda. The purpose of this article is to review current evidence in practice regarding compression therapy for BCRL management and based on this evidence, offer an expert consensus recommendation for a research agenda and prescriptive trials. Recommendations herein focus solely on compression interventions. METHODS: This document represents the proceedings of a session organized by the International Compression Club (ICC) in June 2009 in Ponzano (Veneto, Italy). The purpose of the meeting was to enable a group of experts to discuss the existing evidence for compression treatment in breast cancer related lymphedema (BCRL) concentrating on areas where randomized controlled trials (RCTs) are lacking. RESULTS: The current body of research suggests efficacy of compression interventions in the treatment and management of lymphedema. However, studies to date have failed to adequately address various forms of compression therapy and their optimal application in BCRL. We offer recommendations for standardized compression research trials for prophylaxis of arm lymphedema and for the management of chronic BCRL. Suggestions are also made regarding; inclusion and exclusion criteria, measurement methodology and additional variables of interest for researchers to capture. CONCLUSION: This document should inform future research trials in compression therapy and serve as a guide to clinical researchers, industry researchers and lymphologists regarding the strengths, weaknesses and shortcomings of the current literature. By providing this construct for research trials, the authors aim to support evidence-based therapy interventions, promote a cohesive, standardized and informative body of literature to enhance clinical outcomes, improve the quality of future research trials, inform industry innovation and guide policy related to BCRL.

Quality-of-life and body image impairments in patients with lymphedema.

The psychological and social consequences of chronic lymphedema are still often overlooked, as is the frequency with which they occur. Secondary lymphedema after mastectomy or breast-conservation procedures following the diagnosis of breast cancer is especially common and represents a substantial problem for those affected. The aim of this study was to investigate differences in body image and quality of life (QOL) between female lymphedema patients and trauma patients and to further monitor the changes in female lymphedema patients during three weeks of rehabilitation. This survey was conducted on 80 female patients at the State Hospital of Wolfsberg/Carinthia, Austria, 40 were trauma patients and the other 40 patients had some type of lymphedema, 20 of these patients were located in the general lymphedema ward and 20 in rehabilitation. The Frankfurt Body Image Questionnaire was used to determine body image, and the German version of the Short Form-36 Health Survey was used to determine QOL. The results indicate that female lymphedema patients are greatly affected in various areas of body image and QOL. Lymphedema patients show significantly lower body image scores in seven of nine areas compared to trauma patients. Female lymphedema patients also describe their QOL as being lower in the areas of general health perception, vitality and mental well-being. After rehabilitation, there were improvements in the evaluation of physical functioning and an increased acceptance of the body. Patients also showed a significant increase in health perception, vitality and mental health.

[Post-therapeutic lymphedema of the arm--possibilities and limits of diagnosis and therapy]. / Das posttherapeutische Armlymphödem--Möglichkeiten und Grenzen der Diagnose und Therapie.

The post-therapeutical secondary arm lymphedema is the most frequent complication after a curatively treated cancer of mamma. For the diagnosis and therapy the knowledge of physiology and pathophysiology of lymphedema and of specific anatomy are necessary. The diagnosis facilities are essentially limited to a basic diagnosis (anamnesis, inspection, palpation, sonography, functional-diagnosis). Specific apparative diagnostics like lab, sonography, CT, MRI and PTE have to be applied especially at an early stage of the secondary arm lymphedema for the differential diagnosis between the secondary malign and secondary benign arm lymphedema. Specific apparative examinations like lymphscintigraphy and lymphography are limited and solely indicated for special questions. As a therapy possibility of the secondary arm-lymph edema, a conservative therapy, that is, the complex two-stage-decongestive physiotherapy (CDP) is recommended as first choice. Surgical therapies such as autologous lympho-lymphostatic anastomoses and lymphovenous anastomoses are only recommended in selected individual cases. The secondary malignant arm lymphedema must be primarily treated oncologically; lymphological therapy measures have to be postponed. Diagnosis and therapy are limited through lymphological incompetence and insufficient patient compliance. In this respect the provision of financial resources through National Health policy ist regarded as utterly important.

[Current status of therapy of lymphedema in Austrian hospitals--a comprehensive Austrian survey]. / Ist-Zustand der Therapie des Lymphödems in den Krankenanstalten Osterreichs--eine gesamtösterreichische Umfrage.

The overall Austrian survey of the Austrian Lymph-Liga on the acutal state of the diagnosis and therapy of the hospitals of Austria is represented by making enquiries in 178 hospitals. The response was moderate at 34%, with only 46 hospitals offering a therapy of lymphedemas (approximately 26%). The type of therapy does not seem standardized at the Austrian hospitals. This explains a high number of multiple entries. The conservative therapy recognized internationally today, or rather, the complex-2-stage-decongestive physiotherapy (CDP), is only mentioned in 24% (including multiple entries). The time required per patient per day, the cyclical weekly reception and the total time of the decongestive therapy are very varied compared to the standards recommended today. Personal qualification of the lymph-therapists is given by physiotherapists in the majority. The specialist competence is very different, but it is identified as competent in the majority through specialists of the internal and of physical medicine. Most of the cost of medical care is covered by Compulsory Insurance. The medical care is limited in every second case (it could not be clarified whether there are organisational reasons, staff-related reasons, or financial reasons). Supplementary data of a "Quality of life" survey among lymphedema patients underline the necessity of a concept for standards, diagnosis and therapy. More than half of the patients asked (65%) complained about a time period of 5 to 10 years from the beginning of the illness till the beginning of a definitive therapy. Every other patient does not feel optimally treated and is under an increased pressure of suffering.