Non-pneumatic compression and its clinical utility in management of lymphedema - A position statement

Sep 28, 2026

Lymphedema is a chronic, incurable condition driven by impaired lymphatic drainage, causing progressive swelling and functional limitations. Phlebolymphedema, associated with chronic venous insufficiency, represents a substantial share of lower-extremity cases and contributes to a multi-year economic burden. Although treatment commonly relies on compression, exercise, and limb elevation, pneumatic compression devices face adherence and mobility challenges. This paper evaluates a non-pneumatic compression device combining static compression, sequential gradient compression, and muscle pump activation, reporting improved edema reduction, quality of life, and adherence in randomized trials.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages5

Reading Time13 min

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Abstract

Background

Methods

Results

Conclusions

Non-pneumatic compression treatment

Description

Design and mechanisms of action

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 Glenn R. Jacobowitz, MD,a Ruth Bush, MD, JD, MPH,b Ronald S. Winokur, MD,c and Joseph D. Raffetto, MD,d New York, NY; Galveston, TX; and Boston, MA ABSTRACT 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. (J Vasc Surg Venous Lymphat Disord 2026;14:102356.) Keywords: Lymphedema; Non-pneumatic compression; Phlebolymphedema Lymphedema is caused by impaired lymphatic drainage, leading to fluid accumulation and swelling, primarily in the extremities. Prevalence estimates range from 5 to over 10 million1,2 affected individuals in the United States (U.S. ) . Health economic analyses estimate over $1 billion3 in lymphedema-related health care costs over 5 years. Phlebolymphedema has emerged as a leading cause of lymphedema in the U.S., arising from chronic venous insufficiency (CVI), where elevated venous pressure disrupts lymphatic function. A study by Dean et al found From the Department of Surgery, Northwell Health, New Yorka; the Department of Surgery, UTMB Health, Galvestonb; Department of Radiology, the Weill Cornell Health, New Yorkc; and the Department of Surgery, VA Boston Healthcare System, Boston.d Correspondence: Glenn R. Jacobowitz, MD, Director of Ambulatory Vascular Surgery, Northwell Health. Professor of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 130 East 77th St, 13th Floor, New York, NY 10075 (e-mail: [grjacobowitz44@gmail.com](grjacobowitz44@gmail.com) ) . The editors and reviewers of this article have no relevant financial relationships to disclose per the Journal policy that requires reviewers to decline review of any manuscript for which they may have a conflict of interest. 2213-333X © 2025 THE AUTHOR(S) . Published by ELSEVIER INC. on behalf of the Society for Vascular Surgery. This is an open access article under the CC BY license ([http://creativecommons.org/licenses/by/4.0/](http://creativecommons.org/licenses/by/4.0/)) . [https://doi.org/10.1016/j.jvsv.2025.102356](https://doi.org/10.1016/j.jvsv.2025.102356) phlebolymphedema in 41. 8% of 440 lower extremity lymphedema cases, exceeding cancer-related cases (33 . 9%) .4 The American Venous Forum (2022) recommends treating CVI (CEAP C3-C6) as lymphedema5 to improve management outcomes. Despite its high p

FAQs

What clinical problem does the document address?

It addresses lymphedema, a chronic condition caused by impaired lymphatic drainage leading to progressive swelling and functional impairment.

How does the non-pneumatic compression device (NPCD) work?

The NPCD combines static compression, sequential gradient compression from distal to proximal, and muscle pump activation to support lymphatic drainage and venous return while allowing movement during treatment.

What evidence is provided for the NPCD’s effectiveness compared with pneumatic compression devices?

Two randomized controlled trials showed superior outcomes with the NPCD versus advanced pneumatic compression devices, including greater edema reduction, improved quality of life, and higher adherence.

Sep 28, 2026

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