Effects of Compression Stockings on Elevation of Leg Lymph Pumping Pressure and Improvement of Quality of Life in Healthy Female Volunteers: A Randomized Controlled Trial

Abstract

Background: Lymph is pumped through the collecting lymphatic vessels by both intrinsic and extrinsic forces. The intrinsic pump relies on spontaneous lymphatic contraction, which generates the pumping lymph pressure (Plp). Among healthy people with daily leg edema, a considerable number of cases are accompanied with low leg Plp. Herein, a double-blinded controlled trial was conducted in healthy female volunteers with reduced leg Plp to compare the effectiveness of a 15–29 mmHg compression stocking (Stocking A) and a 8–16 mmHg stocking (Stocking B) on elevating Plp.Method and Results: Among 219 healthy female volunteers who underwent measurement of leg Plp, 80 participants (36.5%) had unilateral or bilateral legs with Plp < 20 mmHg (122 legs with Plp < 20 mmHg and 38 legs with Plp ≧ 20 mmHg). These 80 participants were assigned to wear either Stocking A (n = 40) or Stocking B (n = 40) for 16 weeks. Leg Plp was measured using indocyanine green fluorescence lymphography and an occlusion cuff technique while sitting. At 16 weeks, both Stockings A and B resulted in significantly elevated leg Plp, with the effect on elevating Plp being superior for Stocking A. Only Stocking A resulted in decreased prevalence of leg edema and improved Short Form-36 scores.Conclusion: Compression stockings may represent a therapeutic option to elevate leg Plp and ameliorate leg edema, thereby leading to improved quality of life in healthy females with low leg Plp.

The relationship between lymphangion chain length and maximum pressure generation established through in vivo imaging and computational modeling

“…By fitting our computational model to experimental measurements of the pumping pressure at multiple locations along the tail, we can estimate the average force generation for the chain of lymphatics, decoupling the intrinsic function of that vessel from other extrinsic factors such as interstitial fluid pressure at the injection site. Although measurement of the maximum pumping pressure is known to have the potential as a clinical diagnostic approach for lymphedema (11,63), this study suggests that any measurement of the maximum pumping pressure should be interpreted in the context of chain length; hence, measurements should be performed at multiple locations to provide sufficient information on lymphatic muscle activity in the limb of interest. Because this approach is noninvasive, the potential as a clinical diagnostic in lymphatic health is promising, and future trials in humans are warranted to establish feasibility.…”

“…Although significant advances have been made toward understanding the molecular regulation of lymphatic contractility in both isolated vessels and small animal models, there remains a significant gap in our understanding of how networks of lymphangions work across long distances to move fluid against the unfavorable pressure gradients that exist in vivo. Recent advances by several groups have demonstrated the ability to measure lymphatic pumping pressure in both clinical and animal research settings (7,11,43,45,53,63,66). Similar to blood pressure, which provides a measurement of cardiac pump function, the technique has been suggested to be indicative of the combined capacity of the intrinsic and extrinsic lymphatic pump.…”

Compression Stocking Length Effects on Oedema, Pain, and Satisfaction in Nursing Students: A Pilot Randomized Trial

“…Compression stockings reverse venous blood hypertension, increase skeletal muscle pumps, promote blood return to the veins, and improve lymphatic drainage [ 7 ]. Several studies have reported that compression stockings with pressures of approximately 25–30 mmHg were near effective in reducing leg oedema [ 10 , 11 ]. However, studies specifically examining the side effects of compression stockings are lacking [ 12 , 13 ]; the use of stockings can cause discomfort, pressure necrosis, ischaemia, contact dermatitis, skin discoloration, and blistering [ 14 ].…”

“…Various studies have been conducted to examine the effects of using compression stockings. A randomized controlled trial including the use of compression stockings in healthy adult women reported that their lymphatic pumping pressure was improved [ 11 ]. Additionally, another randomized crossover trial on compression hosiery worn by hairdressers reported reduced discomfort, oedema, and pain in the legs [ 4 ].…”

Pump function curve shape for a model lymphatic vessel

“…The clinical importance of achieving better understanding of lymphatic pumping rests primarily with the role of impaired pumping in lymphoedema. Impairment can arise from surgical interruption of the lymphatic conduit network or from radiation-induced lymphatic muscle dysfunction, but measurements of maximal pumping pressure show that there is also a wide range of pumping ability in normal volunteers [1]. …”