Purpose: Lower extremity lymphedema is the abnormal collection of interstitial fluid, most commonly associated with heart failure, cirrhosis, renal disease, chronic venous insufficiency, and obesity. Over time, the accumulation of fluid can lead to proliferation of adipocytes and deposition of collagen in the extracellular matrix causing pain in the legs, skin changes, and eventual skin breakdown. Treatment is especially challenging in patients with respiratory limitations due to chronic obstructive pulmonary disease. Early treatment allows for reduction of pain, cellulitis, and venous ulcers.
Methods: Patients with lower extremity lymphedema recalcitrant to compression stocking therapy were prescribed an intermittent pneumatic compression pump. Patients were measured for bilateral full-length lower extremity garments and trained on proper application. They were instructed to use the pump daily for 45 minutes on each leg. Pain was measured on a 10 point scale.
Results: This series follows three male veterans who are seen in the high risk podiatry clinic. All three have chronic obstructive pulmonary disease on supplemental oxygen, are obese, and suffer chronic lower extremity pain. The patients in cases 1 and 3 have chronic kidney disease stage 3 and hypertension, which affects fluid balance. The patient in case 2 has chronic venous insufficiency and history of a healed venous ulcer.
Conclusions: All three patients experienced decreased leg pain. There were no episodes of shortness of breath and no hospitalizations for cellulitis, venous ulcer, or respiratory issues. The intermittent pneumatic compression pump is safe to use in patients with chronic obstructive pulmonary disease and is effective in decreasing pain, increasing quality of life.