BACKGROUND: Phlebolymphedema is a challenging condition to manage, with limited options for effective treatment. For patients, this may be debilitating and lead to infection, loss of independence and affect quality of life. This study aims to evaluate patient-reported outcomes of an advanced pneumatic compression device (APCD) in the treatment of lower extremity phlebolymphedema.
METHODS: Patients with diagnosis of lower extremity phlebolymphedema at an acute care facility within the New York City Health and Hospitals Cooperation treated with the Flexitouch (FLX) (Tactile Systems Technology, Inc, Minneapolis, Minnesota) APCD from December 2021 to March 2023 were evaluated. Patient-perceived subjective outcomes were assessed via a short questionnaire, with subsequent analysis using chi-squared test. Primary end points were subjective improvements in 1) swelling, 2) pain, and 3) ease of use of device as surrogates for patient satisfaction. Secondary end point was subjective patient-reported compliance, obtained by investigating 1) if patients were trained to use device, and 2) if patients were using the device.
RESULTS: A total of 52 participants were included in this study, consisting of 30.8% male and 69.2% female patients with a mean age of 71.7 years. While selection criteria did not exclude unilateral disease or alternative etiologies, we note that the entire study population had been diagnosed with bilateral lower extremity lymphedema in the setting of chronic venous insufficiency. Other patient characteristics including race, comorbidities and smoking status were documented in Table 1. Table 2 demonstrates the results of chi-squared analysis. This study noted significant patient-perceived improvement in swelling and pain (91.4% with P < 0.00001; 85.7% with P = 0.00002 respectively) and patient-reported ease of use of the FLX device (85.7% with P = 0.00002). Additional secondary findings included a majority of patients reporting being trained on how to use FLX and also maintaining compliance with the device (69.2% with P = 0.005; 67.3% with P = 0.012 respectively).
CONCLUSIONS: FLX APCD use has been found to demonstrate desirable patient-reported outcomes as a general trend. The participants in this study noted statistically significant subjective improvement in swelling and pain, ease of use of device and adherence to training and compliance with device. FLX appears to be positively received by patients, and the authors recommend its consideration for management of bilateral lower extremity phlebolymphedema.

Transradial access is associated with fewer access site-related complications, earlier patient mobilization, and greater postprocedural comfort. Pseudoaneurysms are an extremely rare complication after transradial procedures and the radial artery itself is the most atypical arterial site of occurrence. We report a case in which a non-surgical, non-invasive, simple, and effective solution (prolonged pneumatic compression) was used to manage a radial artery pseudoaneurysm, a very rare and challenging complication of transradial procedures.
O acesso arterial transradial está associado a menos complicações relacionadas ao sítio de punção, com deambulação precoce do paciente e maior conforto pós-procedimento. O pseudoaneurisma é uma complicação extremamente rara após procedimentos transradiais, sendo a artéria radial, por si só, o sítio mais incomum para tal ocorrência. Relata-se um caso de um pseudoaneurisma de artéria radial, uma complicação rara e desafiadora, resolvido com êxito e de maneira simples, não invasiva e não cirúrgica (compressão pneumática prolongada).

This meta-analysis assessed the effect of pneumatic compression therapy on the wound healing of venous ulcers, with the aim of providing a basis for the selection of clinical treatment. Randomised controlled trials (RCTs) on the application of pneumatic compression therapy to venous ulcers were collected by searching PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, VIP, and Wanfang databases, with a timeframe from database inception to August 2023. After two researchers independently screened the literature, extracted information, and evaluated the quality of the included studies, a meta-analysis was performed using RevMan 5.4 software. Six RCTs with 367 patients were included, with 172 patients in the intervention group and 195 in the control group. The results showed that pneumatic and bandage compression therapies had a similar impact on wound healing rates of venous ulcers (54.65% vs. 53.84%, odds ratio [OR]: 1.02, 95% confidence interval [CI]: 0.49-2.12, p = 0.96), changes in wound area (standardised mean difference: -0.16, 95% CIs: -0.45 to 0.12, p = 0.26), adverse event rates (76.56% vs. 67.07%, OR: 1.62, 95% CI: 0.77-3.39, p = 0.20), and the differences were not statistically significant. Thus, current evidence suggests that the effects of pneumatic compression therapy on wound healing rates, changes in wound area, and the incidence of adverse events in patients with venous ulcers are similar to those of bandage pressure therapy. However, owing to the limitations in the number and quality of studies, more high-quality RCTs are needed to clarify the feasibility and economics of pneumatic compression therapy in patients with venous ulcers.

BACKGROUND: The aim of this study was to examine the efficacy of pneumatic compression of the maternal lower extremities in increasing the amniotic fluid index (AFI) in pregnancies complicated by isolated oligohydramnios.
METHODS: Women with isolated oligohydramnios (AFI <5 cm) at 32-41 weeks of pregnancy were connected to a sequential compression device for 60 min. Prior and after the application, AFI and the pulsatility index (PI) of a number of arteries were measured.
RESULTS: The median (interquartile range) maternal age of the 21 women included was 29 years (26.50-32.00), the median parity was 1 (1-2), and the median gestational age at intervention was 37.60 weeks (37.00-39.40). The median AFI increased after the application from 4.00 (3.62-4.50) to 6.08 cm (4.90-7.03) (p < 0.001). The median PI of the fetal renal artery decreased from 2.30 (2.01-2.88) to 2.26 (1.68-2.71) (p = 0.01). The hourly fetal urine production did not increase. Changes were not significant in the PI of the umbilical artery, the middle cerebral artery, and the bilateral uterine arteries.
CONCLUSIONS: Short-term activation of pneumatic compression on maternal lower extremities could increase the AFI in women with isolated oligohydramnios.

OBJECTIVE: Intermittent pneumatic compression (IPC) applies gradual pressure to facilitate lymph and blood flow movement to reduce exercise-induced tissue fluid accumulation and plasma volume loss. This study aimed to evaluate the cardiovascular system response during the recovery with IPC compared with passive recovery (Sham).
METHODS: Sixteen volunteers (7 females and 9 males) executed a cycling-based exhausting sprint interval exercise (8 × 20 s all out), followed by a 30-min IPC or Sham condition. Participants performed two trials in a randomised, counterbalanced, and crossover design. Several cardiovascular parameters (blood pressure, heart function, and peripheral vascular resistance) were recorded at baseline (5\'), through the recovery protocol (30\'), and afterwards (5\').
RESULTS: The use of IPC during the recovery phase led to a faster recovery, stated in relative values to pre-exercise, in mean blood pressure (102.5 ± 19.3% vs. 92.7 ± 12.5%; P < 0.001), and cardiac output (139.8 ± 30.0% vs. 146.2 ± 40.2%; P < 0.05) in comparison to Sham condition. Furthermore, during the IPC-based recovery, there was a slower recovery in cardiac pressure change over time (92.5 ± 25.8% vs. 100.5 ± 48.9%; P < 0.05), and a faster return to pre-exercise values in the peripheral vascular resistance (75.2 ± 25.5% vs. 64.8 ± 17.4%; P < 0.001) compared to Sham.
CONCLUSIONS: The application of IPC after high-intensity exercise promotes the recovery of the cardiovascular system, reducing cardiovascular strain. Future investigations should consider the effects on the sympathetic-parasympathetic balance, such as heart rate variability, to assess further bonds between the use of IPC and autonomous control.

UNASSIGNED: Arterial leg ulcers (ALUs) pose a considerable burden on patients and health services. The cornerstone of treatment is revascularisation; however, this is not always possible and does not necessarily guarantee ulcer healing. Alternative treatment options are therefore also important. This narrative review aims to summarise the evidence available for non-surgical treatment of ALUs, including topical therapy, pharmacological agents, therapeutic angiogenesis and devices.
UNASSIGNED: A literature search was performed in November 2020 to identify studies reporting data on the non-surgical management of ALUs. Prospective randomised controlled trials (RCTs), controlled clinical trials and meta-analyses that investigated conservative or medical interventions on patients with intractable ALUs, and which provided quantitative data on ulcer healing were included. Following screening, studies that met the inclusion criteria underwent a data extraction process and findings were synthesised and categorised narratively.
UNASSIGNED: In total, 14 controlled trials were selected for inclusion and analysed based on experimental protocol and outcome measures.
UNASSIGNED: There is some evidence available for the use of short-term systemic prostanoids, ultrasound therapy and pneumatic compression. There are limitations to these options including side effects, patient tolerance due to pain and availability in clinical practice. Further research is needed to improve treatment options for this complex group.

BACKGROUND: The presence of localised oedema can make measurement and removal of excess fluid in haemodialysis challenging.
OBJECTIVE: To evaluate (i) the effectiveness of intermittent pneumatic compression and neuromuscular electrical stimulation at mobilising oedema and (ii) the impact of localised fluid on bioimpedance measured fluid status.
METHODS: A single centre, cross-over study design. Participants were monitored weekly during mid-week dialysis sessions. Four sessions with each of the interventions and no interventions, with washout periods between, were included.
METHODS: Six participants with lower limb oedema and established on haemodialysis for at least 3 months.
METHODS: The effectiveness of mobilising oedema and improving haemodynamic stability was assessed by: reduction in ankle circumference; ultrafiltration volume achieved; blood pressure changes; participant symptoms and achievement of target weight. The impact of localised fluid on bioimpedance measurements was assessed by comparing measurements across affected tissue with measurements avoiding the site of oedema.
RESULTS: There were no differences in ultrafiltration volumes, achievement of target weight, participant symptoms or reductions in ankle circumference and systolic blood pressure between intermittent pneumatic compression and neuromuscular electrical stimulation sessions compared to control sessions. Measurements of fluid overload with bioimpedance were 1.7 and 1.8 L higher when measuring across oedematous tissue compared to non-oedematous tissue.
CONCLUSIONS: We were unable to demonstrate improved mobilisation of fluid in the participant\'s lower limb, though there was a low number of study participants and notable interindividual variation observed. Bioimpedance offers potential for monitoring fluid management in individuals with lower limb oedema but specific protocols are necessary.

OBJECTIVE: To determine the thrombotic and hemorrhagic risk in bariatric surgery with multimodal rehabilitation programs, comparing two guidelines of pharmacological prophylaxis recommended in the Guide to the Spanish Society for Obesity Surgery and the Obesity Section of the AEC.
METHODS: Cohorts retrospective study from January-2010 to December-2019. Cases of vertical gastrectomy or gastric bypass were recorded, systematically applying multimodal rehabilitation protocols. Two reduced chemoprophylaxis regimens were analyzed, starting after surgery and maintained for 10 days; one with fondaparinux (Arixtra®) at a fixed dose of 2.5mg/day and the other with enoxaparin (Clexane®) with a single daily dose adjusted to BMI: 40mg/day for BMI of 35-40 and 60mg/day for BMI 40-60.
RESULTS: 675 patients were included; 354 with Fondaparinux-Arixtra® during the period 2010-2015 and 321 with Enoxaparin-Clexane® during the period 2016-2019. There were no cases of DVT or clinical PE. However, the incidence of hemorrhage requiring reoperation, transfusion, or a decrease of more than 3g/dL hemoglobin was 4.7%, with no difference between groups. Mortality was nil. The average stay was 2.8 days and the outpatient follow-up was 100% during the first 6 months and 95% at 12 months.
CONCLUSIONS: The combination of multimodal rehabilitation programs and mechanical and pharmacological thromboprophylaxis by experienced teams, reduces the risk of thromboembolic events and could justify reduced chemoprophylaxis regimens to decrease the risk of postoperative bleeding.

Background: Upper limb lymphedema may be revealed after breast cancer and its treatment. Among different treatment approaches, intermittent pneumatic compression (IPC) therapy and low-level laser therapy (LLLT) are reported as effective modalities in the treatment of postmastectomy upper limb lymphedema (PML). The aim of the current study is to investigate the long-term effectiveness of combined IPC plus LLLT versus IPC therapy alone in patients with PML. Methods and Results: The patients were allocated into two groups in this single-blinded, controlled clinical trial. Group I received combined treatment with IPC plus LLLT (n = 21) and group II received only IPC (n = 21). IPC treatment was given 5 sessions per week for 4 weeks (20 sessions). LLLT was also performed 5 sessions per week for 4 weeks (20 sessions). Clinical evaluations were performed before and after the treatment at the 3, 6, and 12-month follow-up visits. According to within-group analysis, statistically significant improvements in the circumference difference (Cdiff) and grip strength were observed in both groups (for Cdiff, p = 0.018 and p = 0.032, respectively; for grip strength, p = 0.001 and p = 0.046, respectively). Visual analog scale values for arm pain and shoulder pain during motion were decreased only in group I. Conclusion: Both interventions have positive effects on lymphedema, grip strength, and pain. Long-term effects of combined therapy, especially on pain, are slightly superior to the pneumatic compression alone.

Objective: The aim of this study is to investigate the effect of complex decongestive physiotherapy (CDP) plus intermittent pneumatic compression (IPC) applications on upper extremity circumference and volume in patients with lipedema. Methods and Results: All participants included in the study were included in a treatment protocol consisting of CDP and IPC. The Perometer 400 NT was used in the measurement of upper extremity volume and circumference before and after treatment. The measurements were performed in four reference points. According to the Perometer results before and after CDP, statistically significant reduction was found in the circumference of 3 of the 4 points of measurements performed in each of the left and right upper extremities. When the volume assessments were compared, it was seen that statistically significant reduction was found in the volume of both limbs. Conclusion: A treatment program consisting of CDP and IPC can be effective in reducing the circumference and volume of the arm in patients with upper extremity lipedema. So, CDP applications can help prevent the development of complications such as lipolymphedema, hypertension, and heart failure. Clinical Trial Registration number: NCT04643392 https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000AF9B&selectaction=Edit&uid=U00055NT&ts=2&cx=-3oevdw.