Health and economic benefits of advanced pneumatic compression devices in patients with phlebolymphedema

Lerman, Michelle; Gaebler, Julia; Hoy, Sunday; Izhakoff, Jessica; Gullett, Laura; Niecko, Timothy; Karaca‐Mandic, Pinar; O’Donnell, Thomas F.; Rockson, Stanley G.

doi:10.1016/j.jvs.2018.04.028

Cited by 22 publications

(19 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The prevailing opinion that flat-knit garments provide intrinsically better containment than other garments was challenged by a study published by the International Compression Club (ICC) which concluded that the dynamic stiffness of circular and flat knit fabrics are not different. 42 Although flat knit may be a heavier fabric, the study concluded that once a piece of fabric has a stretch to it (which both flat and circular knit have), then the stiffness is not very high. We believe that the above analysis provides a good working understanding of the circular and flat knit garments.…”

Section: Results and Commentsmentioning

confidence: 99%

“… 40 Two commercial claims-based studies demonstrated significant reduction in healthcare costs associated with the use of an advanced SPC device; one was in a mixed population of cancer and non-cancer associated lymphedema of both the upper and lower extremities, 41 and the other was in a population of phlebolymphedema patients, almost all of whom had either C5 or C6 CVI. 42 In both cases, the cost reduction was primarily driven by the reduced requirement for inpatient and outpatient treatment for cellulitis as well as reduced use of physical and occupation therapy.…”

Section: Results and Commentsmentioning

confidence: 99%

“…Specifically, a longitudinal matched case-control analysis of deidentified private insurance claims found that, compared to conservative therapy, APCD was associated with 69% lower total phlebolymphedema-and sequelae-related costs per patient and per year net of any pneumatic compression devicerelated costs. 42 Unfortunately, most studies, including the latter, do not distinguish among ISL stages of lymphedema as it pertains to treatment efficacy with SPC. Moreover, while numerous studies have established that SPC can improve QOL for patients with lymphedema (irrespective of etiology; primary vs secondary), inability to reliably control for patient compliance with regular use of pneumatic devices may limit the interpretation of results.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

The American Venous Forum, American Vein and Lymphatic Society and the Society for Vascular Medicine expert opinion consensus on lymphedema diagnosis and treatment

et al. 2022

View full text Add to dashboard Cite

Background Lymphedema imposes a significant economic and social burden in modern societies. Controversies about its risk factors, diagnosis, and treatment permeate the literature. The goal of this study was to assess experts’ opinions on the available literature on lymphedema while following the Delphi methodology. Methods In December of 2019, the American Venous Forum created a working group tasked to develop a consensus statement regarding current practices for the diagnosis and treatment of lymphedema. A panel of experts was identified by the working group. The working group then compiled a list of clinical questions, risk factors, diagnosis and evaluation, and treatment of lymphedema. Fifteen questions that met the criteria for consensus were included in the list. Using a modified Delphi methodology, six questions that received between 60% and 80% of the votes were included in the list for the second round of analysis. Consensus was reached whenever >70% agreement was achieved. Results The panel of experts reached consensus that cancer, infection, chronic venous disease, and surgery are risk factors for secondary lymphedema. Consensus was also reached that clinical examination is adequate for diagnosing lymphedema and that all patients with chronic venous insufficiency (C3–C6) should be treated as lymphedema patients. No consensus was reached regarding routine clinical practice use of radionuclide lymphoscintigraphy as a mandatory diagnostic tool. However, the panel came to consensus regarding the importance of quantifying edema in all patients (93.6% in favor). In terms of treatment, consensus was reached favoring the regular use of compression garments to reduce lymphedema progression (89.4% in favor, 10.6% against; mean score of 79), but the use of Velcro devices as the first line of compression therapy did not reach consensus (59.6% in favor vs 40.4% against; total score of 15). There was agreement that sequential pneumatic compression should be considered as adjuvant therapy in the maintenance phase of treatment (91.5% in favor vs. 8.5% against; mean score of 85), but less so in its initial phases (61.7% in favor vs. 38.3% against; mean score of 27). Most of the panel agreed that manual lymphatic drainage should be a mandatory treatment modality (70.2% in favor), but the panel was split in half regarding the proposal that reductive surgery should be considered for patients with failed conservative treatment. Conclusion This consensus process demonstrated that lymphedema experts agree on the majority of the statements related to risk factors for lymphedema, and the diagnostic workup for lymphedema patients. Less agreement was demonstrated on statements related to treatment of lymphedema. This consensus suggests that variability in lymphedema care is high even among the experts. This information should be considered by developers of future practice guidelines for lymphedema, especially in cases of low-level evidence that supports practice patterns with which the majority of experts disagree.

show abstract

Section: Results and Commentsmentioning

confidence: 99%

Section: Results and Commentsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

The American Venous Forum, American Vein and Lymphatic Society and the Society for Vascular Medicine expert opinion consensus on lymphedema diagnosis and treatment

et al. 2022

View full text Add to dashboard Cite

show abstract

“…There are a number of studies demonstrating the benefits of advanced PCGT, particularly with regard to the overall improvement in economic burden to the health care system when compared to CDT. [7][8][9] However, only one paper has looked at feasibility and outcomes of the device in the head and neck population. In addition to subjective assessments of overall patient satisfaction with the device, this paper by Mayrovitz et al exclusively used external facial and neck measurements as its principle objective outcome.…”

Section: Introductionmentioning

confidence: 99%

Pilot Study: Pneumatic Compression Garment Therapy for Postradiotherapy Laryngopharyngeal Edema

et al. 2020

View full text Add to dashboard Cite

Objectives: Pneumatic compression garment therapy (PCGT) has been established as treatment for postradiotherapy lymphedema, and its use in head and neck patients is becoming more common. Although effects on interstitial edema of the cervical soft tissues have been studied, effects on internal laryngopharyngeal edema, as well as associated symptoms of dysphagia and dysphonia, have yet to be published. Methods: We surveyed 7 patients treated with radiation for head and neck cancer (HNC) who had also been prescribed PCGT for cervical lymphedema. Patients were asked about subjective experience with the device, and also administered the Eating Assessment Tool-10 (EAT-10) and Voice Handicap Index-10 (VHI-10) surveys regarding their symptoms after using PCGT. Laryngoscopy videos from these same periods were also reviewed and scored using a validated tool for assessing laryngopharyngeal edema. Results: 85% of patients reported at least some improvement in dysphagia and dysphonia following PCGT. Average EAT-10 score after PCGT was 11.4 and average VHI-10 score after PCGT was 8.7. These compare more favorably to historical scores for the same questionnaires in similar patient populations. Laryngeal edema scores on endoscopic examination were not significantly different after at least 3 months of therapy (pre: 20.15, post: 20.21, P = .975); however, the utility of this result is limited by a low inter-rater reliability (Krippendorff α = .513). Conclusions: While we are unable to show any difference in objective assessment of laryngopharyngeal edema on endoscopic examination in this small pilot study, patients report substantial subjective improvement in postradiotherapy dysphagia and dysphonia following cervical PCGT that warrants more formal investigation.

show abstract

Lymphedema

Yamamoto

2022

Approach to Lower Limb Oedema

View full text Add to dashboard Cite

Health and economic benefits of advanced pneumatic compression devices in patients with phlebolymphedema

Abstract: This analysis indicates significant benefits attributable to FLX compared with alternative compression therapies that can help reduce the notable economic burden of phlebolymphedema.

Cited by 22 publications

References 25 publications

The American Venous Forum, American Vein and Lymphatic Society and the Society for Vascular Medicine expert opinion consensus on lymphedema diagnosis and treatment

The American Venous Forum, American Vein and Lymphatic Society and the Society for Vascular Medicine expert opinion consensus on lymphedema diagnosis and treatment

Pilot Study: Pneumatic Compression Garment Therapy for Postradiotherapy Laryngopharyngeal Edema

Lymphedema

Contact Info

Product

Resources

About