Non-pneumatic compression and its clinical utility in management of lymphedema. A position statement endorsed by the American Venous Forum and the American Venous and Lymphatic Society.

BACKGROUND: Lymphedema is a chronic, incurable condition caused by impaired lymphatic drainage, leading to progressive swelling and functional impairment. Phlebolymphedema, a subtype linked to chronic venous insufficiency (CVI), accounts for 41.8% of lower extremity lymphedema cases and contributes to an economic burden exceeding $1 billion over 5 years. Despite its high prevalence, lymphedema remains underdiagnosed and undertreated. Current management relies on compression therapy, exercise, and limb elevation, with pneumatic compression devices (PCDs) as adjuncts. However, PCDs present limitations, including user immobilization, poor adherence, and inadequate muscle pump activation, highlighting the need for more effective, patient-centered therapies.

METHODS: This paper evaluates the use of a non-pneumatic compression device (NPCD) that integrates static compression, sequential gradient compression (distal to proximal), and muscle pump activation.

RESULTS: In two randomized controlled trials, NPCD demonstrated superior outcomes over advanced PCDs, including greater edema reduction, improved quality of life, and higher adherence rates. Unlike traditional PCDs, NPCD enables active movement during treatment, optimizing lymphatic drainage and venous return.

CONCLUSIONS: Given its distinctive multi-modal mechanisms and advantages, NPCD represents a clinically safe and effective, user-friendly alternative to PCDs, aligning with current best practices in vascular and lymphatic medicine. Its inclusion in future lymphedema treatment guidelines should be considered.