Manual lymphatic drainage for chronic venous insufficiency

NewsBot · Feb 2, 2016

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Venous flow during manual lymphatic drainage applied to different regions of the lower extremity in people with and without chronic venous insufficiency: a cross-sectional study
R.S. dos Santos Cris?stomo, M.S. Candeias, P.A.S. Armada-da-Silva
Physiotherapy; Article in Press

Objectives
To evaluate the effect of manual lymphatic drainage (MLD) on venous flow when applied to the medial and lateral aspects of the thigh and leg in patients with chronic venous insufficiency (CVI) and healthy subjects.

Design
Cross-sectional study.

Setting
Participants were assessed in a school-based health community attendant service.

Participants
Fifty-seven subjects participated in this study {mean age: 43 [standard deviation (SD) 14] years, 38 women and 19 men}. Of these, 28 subjects had CVI [mean age 47 (SD 12) years] and 29 subjects did not have CVI [mean age 39 (14) years].

Intervention
MLD was applied by a certificated physical therapist to the medial and lateral aspects of the thigh and leg.

Main outcome measurements
Cross-sectional area; blood flow velocities in the femoral vein, great saphenous vein, popliteal vein and small saphenous vein at baseline and during MLD, measured by duplex ultrasound.

Results
Flow volume in the femoral vein increased from baseline [5.19 (SD 3.25) cm3/second] when MLD was applied to the medial [7.03 (SD 3.65) cm3/second; P≤0.001; mean difference -1.69; 95% confidence interval (CI) -2.418 to -0.968] and lateral [6.16 (SD 3.35) cm3/second; P≤0.001; mean difference -1.04; 95% CI -1.699 to -0.389] aspects of the thigh. Venous flow augmentation in the femoral vein and great saphenous vein was higher when MLD was applied to the medial aspect of the thigh (P < 0.001), while MLD had a similar effect on venous blood flow regardless of whether it was applied to the medial or the lateral aspect of the leg (P = 0.731).

Conclusions
MLD increases blood flow in deep and superficial veins. MLD should be applied along the route of the venous vessels for improved venous return.
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NewsBot · Dec 9, 2017

Lymphatic drainage efficiency: a new parameter of lymphatic function.
Keramida G et al
Acta Radiol. 2017 Jan 1:284185117744226. doi: 10.1177/0284185117744226.

Background Following convection from blood capillaries, plasma proteins are transported to loco-regional lymph nodes in two stages: first, uptake into peripheral lymphatics, and second, transport to nodes. Purpose To introduce a new parameter of lymphatic function that quantifies stage 2 - lymphatic drainage efficiency (LDE). Material and Methods Percentage injected activity (IIQ) in ilio-inguinal nodes 150 min following subcutaneous foot web-space injection of Tc-99 m-nanocolloid was measured in 102 patients undergoing lymphoscintigraphy using a method in which a standard is placed by image guidance over the nodes. Percentage activity leaving the injection depot by 150 min ( k) was measured in 60/102 patients. LDE (%) = 100 × (IIQ/ k). Abnormal lymphoscintigraphy was defined qualitatively as: (i) no activity in ilio-inguinal nodes at 45 min or negligible activity at 150 min (delay); (ii) lymph diversion through skin and/or deep system; and (iii) focal tracer accumulation suggesting cellulitis. Results Scintigraphy was bilaterally normal in 82 limbs, unilaterally normal in 40 limbs and abnormal in 82 limbs. IIQ correlated with k in bilaterally normal (r = 0.86; n = 52), unilaterally normal (r = 0.67; n = 27), and abnormal (r = 0.82; n = 41) limbs. IIQ, k, and LDE were significantly lower in unilaterally normal (9.3 ± 5.4%, 13.8 ± 7.1%, and 65 ± 30%) compared with bilaterally normal limbs (15.4 ± 8.4% [ P > 0.0001], 18.3 ± 8.9% [ P = 0.025], and 84 ± 30% [ P = 0.01]). LDE was lower in limbs displaying skin diversion and/or delay. Conclusion LDE is a new quantitative index that has potential value in clinical research but requires further clinical evaluation. Abnormal quantitative indices indicate that limbs unilaterally normal on lymphoscintigraphy are not functionally normal.
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