title: Efficacy of a short course of complex lymphedema therapy or graduated compression stocking therapy in the treatment of post-thrombotic syndrome.
abstract: Treatment options for established post-thrombotic syndrome (PTS) are limited. Complex lymphedema therapy (CLT), a non-invasive treatment that improves lymphatic flow, may have the potential to improve PTS. We conducted a single-center, investigator-blind, randomized controlled trial of 31 patients with a clinically established diagnosis of PTS and compared the efficacy of graduated compression stockings alone (30-40 mmHg) with CLT, a treatment that includes compression stockings, exercise, patient education, skin care and lymphatic drainage. Primary outcomes were the 1- and 3-month changes in PTS severity by the Villalta score and disease-specific quality of life using the VEINES-QOL (Venous Insufficiency Epidemiological and Economic Study Quality of Life) questionnaire. Analysis was by intent-to-treat. We found from a baseline average score of 9.9 points, CLT reduced mean PTS severity scores by -2.4 points (p=0.02) at the 1-month and -2.3 points (p=0.05) at the 3-month follow-up. Score reductions with stockings only were similar at -2.1 (p=0.03) and -3.3 points (p=0.03) at 1 and 3 months. The differences in score between treatments were not significant. Neither treatment significantly changed the VEINES-QOL score except in patients with severe disease. Patients with moderate to severe PTS derived the greatest benefit from either therapy and the two therapies differentially impacted PTS signs and symptoms. We found a short course of lymphedema therapy and compression stockings offer similar benefit in patients with PTS; however, larger studies are needed to further explore the potential use of CLT in PTS, particularly in patients with more severe disease. ClinicalTrials.gov Identifier: NCT00633971.
authors.affiliation: Department of Medicine, University of Vermont, Burlington, VT, USA.
authors.forename: Chris E
authors.initials: CE
authors.lastname: Holmes
authors.forename: Nadia M
authors.initials: NM
authors.lastname: Bambace
authors.forename: Patricia
authors.initials: P
authors.lastname: Lewis
authors.forename: Peter W
authors.initials: PW
authors.lastname: Callas
authors.forename: Mary
authors.initials: M
authors.lastname: Cushman
mesh_terms: D000328:Adult; D000368:Aged; D015444:Exercise / Q000502:physiology; D005260:Female; D006801:Humans; D008209:Lymphedema / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D054070:Postthrombotic Syndrome / Q000628:therapy*; D011788:Quality of Life; D053828:Stockings, Compression; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014689:Venous Insufficiency / Q000628:therapy
keywords: compression stockings; deep vein thrombosis; lymphedema therapy; post-thrombotic syndrome