Efficacy of complete decongestive therapy in phlebolymphedema: What is the impact of disease stage and BMI on treatment response?

Abstract

Objective

Phlebolymphedema is a progressive condition caused by combined venous and lymphatic dysfunction. Although complete decongestive therapy (CDT) is widely used in clinical practice, objective evidence regarding its effectiveness across different disease stages is limited. This study aimed to evaluate the short-term effectiveness of CDT in patients with lower extremity phlebolymphedema and to examine the influence of disease stage and body mass index (BMI) on treatment response.

Methods

This retrospective study included patients with phlebolymphedema treated at a tertiary lymphedema clinic between 2020 and 2024. Chronic venous insufficiency was diagnosed by lower-extremity venous duplex Doppler ultrasonography, and lymphatic dysfunction was confirmed by lymphoscintigraphy. All patients completed a standardized intensive CDT program consisting of manual lymphatic drainage, multilayer compression bandaging, and therapeutic exercises for 10 sessions over 2 weeks. Extremity volume was measured using circumferential measurements and calculated with the truncated cone formula. Pre- and post-treatment volumes were compared, and associations with disease stage and BMI were analyzed.

Results

62 patients (72.2% female), corresponding to 108 affected lower extremities, were analyzed. The mean BMI was 36.5 ± 6.3 kg/m². CDT resulted in a statistically significant reduction in extremity volume (median reduction: 0.55 L; p < .001). Treatment response differed across disease stages, with greater absolute volume reduction observed in Stage 3 disease (p = .007). A positive correlation was identified between BMI and volume reduction (ρ = 0.322, p = .0007). Age, sex, and history of venous surgery were not associated with treatment response.

Conclusion

CDT is an effective treatment modality for achieving a significant short-term reduction in extremity volume in patients with phlebolymphedema. Clinically meaningful volume reduction can be achieved across all disease stages, including patients with advanced-stage disease and elevated BMI. These findings support the role of CDT as a primary conservative treatment option in routine phlebolymphedema management.

Keywords

chronic venous insufficiency compression bandaging doppler ultrasound lymphoedema obesity

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