# The effect of prolonged complex decongestive therapy for lower limb secondary lymphedema

## TL;DR

Long-term complex decongestive therapy for lower limb lymphedema showed mixed results, with half of patients experiencing increased limb volume over time.

## Contribution

This study identifies factors linked to worsening lymphedema during long-term therapy, including BMI and compression device use.

## Key findings

- 46% of patients experienced increased limb volume during prolonged therapy.
- Higher BMI and inadequate compression device use were linked to volume increase.
- Edema in the calf area was a key indicator of worsening lymphedema.

## Abstract

To clarify the effect of prolonged complex decongestive therapy (CDT) on limb volume in patients with lower limb lymphedema (LLL).

We reviewed patients who first visited our clinic for cancer-related LLL between April 2009 and March 2015 and continued CDT at our clinic for 7 years or longer. At 6- to 12-month intervals, limb volume was calculated from tape measurements, and ultrasound examination was performed to evaluate changes in the skin and subcutaneous tissue conditions.

In 52 patients (68 lower limbs) who were on CDT for a median of 11.2 years, 54% maintained reduced limb volume, whereas limb volume increased in 46% of patients compared with their initial visits. An increase in circumference was mainly observed in the calf area, where the subcutaneous echo-free space (edema) increased. In multivariate analysis, relevant factors associated with the increase in limb volume were an increase in body mass index (odds ratio, 1.73; 95% confidence interval [CI], 1.15-2.93), the use of compression devices for fewer than 5 days per week (odds ratio, 4.57; 95% CI, 1.06-23.53), and the use of compression devices with interface pressure lower than 20 mm Hg (odds ratio, 36.47; 95% CI, 3.42-1061.90).

During prolonged CDT, limb volume increased in 46% of limbs with LLL, which was associated with an increase in edema, particularly in the calf area. The factors associated with increased limb volume were an increase in body mass index, the use of compression devices for fewer than 5 days per week, and the use of compression devices with interface pressure <20 mm Hg.