Effect of sequential intermittent pneumatic compression on both leg lymphedema volume and on lymph transport as semi-quantitatively evaluated by lymphoscintigraphy

Sequential Intermittent Pneumatic Compression (SIPC) is an accepted method for treatment of peripheral lymphedema. This prospective study evaluated th e effect in 11 patients of a single session of SIPC on both lymphedema volu me of the leg and isotope lymphography (99Tc dextran) before SIPC (control) and 48 hours later after a 3 hour session of SIPC. Qualitative analysis of the 2 lymphoscintigrams (LS) was done by image interpretation by 3 physici ans on a blind study protocol. The LS protocol attributed an index score ba sed on the following variables: appearance, density and number of lymphatic s, dermal backflow and collateral lymphatics in leg and thigh, visualizatio n and intensity of popliteal and inguinal lymph nodes. Volume of the leg ed ema was evaluated by measuring limb circumference before and after SIPC at 6 designated sites. Whereas there was a significant reduction of circumference in the leg after SIPC (p<0.05), there was no significant difference in the index scores of the LS before and after treatment. This acute or single session SIPC sugges ts that compression increased transport of lymph fluid (i.e., water) withou t comparable transport of macromolecules (i.e., protein). Alternatively, SI PC reduced lymphedema by decreasing blood capillary filtration (lymph forma tion) rather than by accelerating lymph return thereby restoring the balanc e in lymph kinetics responsible for edema in the first place.