Regular Compression Therapy May Not Be Necessary for Lymphedema in Arms without a Subcutaneous Echo-Free Space
Related Experiment Video
Updated: Jan 19, 2026
Lymphedema Ultrasonography: A Technique to Measure the Change in Thickness of an Affected Tissue
Published on: April 30, 2023
Kotaro Suehiro1, Noriyasu Morikage1, Takasuke Harada1
1Division of Vascular Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan.
Insights
Complex decongestive therapy (CDT) effectively reduces arm lymphedema when a subcutaneous echo-free space (SEFS) is present. However, CDT shows limited effectiveness in reducing arm lymphedema without SEFS.
Area of Science:
- Medical imaging
- Vascular medicine
- Lymphedema management
Background:
- Lymphedema is a chronic condition characterized by fluid accumulation.
- Subcutaneous tissue ultrasonography can identify a subcutaneous echo-free space (SEFS).
- The presence of SEFS may influence treatment outcomes for arm lymphedema.
Purpose of the Study:
- To investigate the efficacy of prolonged complex decongestive therapy (CDT) for arm lymphedema.
- To determine if the presence or absence of a subcutaneous echo-free space (SEFS) impacts CDT effectiveness.
- To evaluate CDT's effect on limb volume reduction in lymphedema patients.
Main Methods:
- Retrospective evaluation of 51 patients with arm lymphedema treated with CDT for over one year.
- Pre-treatment ultrasonography to assess for SEFS.
- Measurement of limb circumference and calculation of limb volume at baseline and follow-up.
Main Results:
- CDT significantly reduced edema ratio by -15% in patients with SEFS (n=25).
- In patients without SEFS (n=26), CDT did not significantly change the edema ratio (median 1%).
- Arms without SEFS not regularly treated with sleeves showed no significant edema increase.
Conclusions:
- Complex decongestive therapy (CDT) demonstrates limited efficacy in reducing arm lymphedema volume when a subcutaneous echo-free space (SEFS) is absent.
- The presence of SEFS on ultrasonography may predict a better response to CDT for arm lymphedema.
Background:
To study the effect of prolonged complex decongestive therapy (CDT) on lymphedema in arms without a subcutaneous echo-free space (SEFS) on subcutaneous tissue ultrasonography.
Methods:
Fifty-one patients with arm lymphedema treated for longer than 1 year using CDT in our clinic were retrospectively evaluated. Before starting CDT, subcutaneous tissue ultrasonography was performed to examine for the presence of an SEFS. Two-stage CDT was performed as recommended by the International Society of Lymphology. Limb circumference was measured, and limb volume was calculated at the initial and latest visits.
Results:
In patients with lymphedema in which SEFS was observed anywhere in the arm on the initial visit (n = 25), the edema ratio was significantly reduced by a median of -15% (range, -106% to 17%; P < 0.001). On the other hand, in the arms with lymphedema in which SEFS was not observed (SEFS[-], n = 26), the edema ratio was not changed significantly by CDT (median, 1% [range, -30% to 23%]). In arms without an SEFS that were not treated using arm sleeves regularly (n = 15), no increase in edema ratio was observed (median, 1% [range, -29% to 16%]).
Conclusions:
In arms with lymphedema without SEFS, the effect of CDT on the reduction of arm volume is limited.
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