title: Manual lymphatic drainage in chronic venous disease: a duplex ultrasound study.
abstract: OBJECTIVE
  To compare the effect of call-up and reabsorption maneuvers of manual lymphatic drainage on blood flow in femoral vein and great saphenous vein in patients with chronic venous disease and healthy controls.
  
  
  METHODS
  Forty-one subjects participated in this study (mean age: 42.68(15.23)), 23 with chronic venous disease (chronic venous disease group) with clinical classification C1-5 of clinical-etiological-anatomical-pathological (CEAP) and 18 healthy subjects (control group). Call-up and reabsorption maneuvers were randomly applied in the medial aspect of the thigh. The cross-sectional areas, as well as the peak and the mean blood flow velocity at femoral vein and great saphenous vein, were assessed by Duplex ultrasound at the baseline and during maneuvers. The venous flow volume changes were calculated.
  
  
  RESULTS
  The venous flow volume in femoral vein and great saphenous vein increased during both manual lymphatic drainage maneuvers and in both groups (P < 0.05). The two maneuvers had a similar effect on femoral vein and great saphenous vein hemodynamics, and in both the chronic venous disease and control groups. As a result of the call-up maneuver, the flow volume augmentations, as a result of call-up maneuver, decreased with the severity of chronic venous disease in those patients measured by the clinical classification of CEAP (r = -0.64; P = 0.03).
  
  
  CONCLUSIONS
  Manual lymphatic drainage increases the venous blood flow in the lower extremity with a magnitude that is independent from the specific maneuver employed or the presence of chronic venous disease. Therefore, manual lymphatic drainage may be an alternative strategy for the treatment and prevention of venous stasis complications in chronic venous disease.
authors.affiliation: Laboratório de Biomecânica e Morfologia Funcional (LBMF), Faculdade de Motricidade Humana, Universidade de Lisboa, Estrada da Costa, 1499-002 Lisboa, Portugal Centro Interdisciplinar Para o Estudo da Performance Humana (CIPER), Faculdade de Motricidade Humana, Universidade de Lisboa, Estrada da Costa, 1499-002 Lisboa, Portugal Instituto Politécnico de Castelo Branco, Escola Superior de Saúde Dr. Lopes Dias, Castelo Branco, Portugal crisostomo.rute@ipcb.pt/crisostomo.rute@gmail.com.
authors.forename: Rute Sofia
authors.initials: RS
authors.lastname: Dos Santos Crisóstomo
authors.affiliation: Cardiotime, Lda., Elvas, Portugal.
authors.forename: Miguel Sandu
authors.initials: MS
authors.lastname: Candeias
authors.affiliation: Instituto Politécnico de Castelo Branco, Escola Superior de Saúde Dr. Lopes Dias, Castelo Branco, Portugal.
authors.forename: Ana Margarida Martins
authors.initials: AM
authors.lastname: Ribeiro
authors.affiliation: Instituto Politécnico de Castelo Branco, Escola Superior de Saúde Dr. Lopes Dias, Castelo Branco, Portugal.
authors.forename: Catarina
authors.initials: C
authors.lastname: da Luz Belo Martins
authors.affiliation: Laboratório de Biomecânica e Morfologia Funcional (LBMF), Faculdade de Motricidade Humana, Universidade de Lisboa, Estrada da Costa, 1499-002 Lisboa, Portugal Centro Interdisciplinar Para o Estudo da Performance Humana (CIPER), Faculdade de Motricidade Humana, Universidade de Lisboa, Estrada da Costa, 1499-002 Lisboa, Portugal.
authors.forename: Paulo As
authors.initials: PA
authors.lastname: Armada-da-Silva
mesh_terms: D000328:Adult; D001783:Blood Flow Velocity; D002908:Chronic Disease; D005260:Female; D005268:Femoral Vein / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D007866:Leg / Q000098:blood supply; D008208:Lymphatic System / Q000503:physiopathology*; D008297:Male; D008405:Massage; D008875:Middle Aged; D012501:Saphenous Vein / Q000000981:diagnostic imaging / Q000503:physiopathology; D016037:Single-Blind Method; D018616:Ultrasonography, Doppler, Duplex; D014689:Venous Insufficiency / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*
keywords: Manual lymphatic drainage; chronic venous disease; duplex ultrasound; venous flow