b'Diagnosis of Primary, Secondary, orExacerbation of Existing LymphedemaConsider the following treatment optionsConservative Management Interventional Therapies Surgical Consultative Risk reduction and Venoplasty and stentingSuction-assisted lipectomy GeneticssurveillanceVenous and lymphatic(including surgical Psychiatric and/orComplete lymphaticsclerotherapy follow-up) Psychological Servicesdecongestive therapyThoracic duct Tumescent liposuctionPulmonary Medicine LANA-certied orembolizationLymphaticovenous Gastroenterologyequivalent practitioner anastomosisGynecology Short stretch bandagingVascularized lymph Oncology Management of vascularnode transferDiagnostic and and other complex Pleurodesis and shunts Interventional Radiologymalformations, or Dermatologyoverlapping vascular/Urologylymphatic conditionsRadiation Oncology Management of protein-Nutritionlosing enteropathies, Plastic Surgerychylothorax, chyloperitoneium, mTOR inhibitors/other pharmacotherapies for lymphatic malformations and complex vascular lesionsFigure 6. Algorithm with Options in the Treatment of Lymphedemareduce edema via a compression gradient. Bandagingshould be measured by an experienced lymphedema is applied in a specific pattern to maximizetherapist. Daytime compression garments (circular or mobilization of edema.flat knit) should be utilized during all waking hours of In conjunction with multilayer compression bandaging,the day and certain nighttime devices may be utilized for overnight maintenance. Nighttime garmentsmanual lymphatic drainage (MLD) should be utilized torange from VELCRO bandage alternative devices to increase uptake of lymph into lymph vessels, increasefoam-based custom pieces. Compression garments lymph production, and to increase venous return. should be replaced every six months to achieveMLD has an analgesic effect and can help to alleviatequality containment of the affected region. Some symptomatic swelling. Exercise that incorporates theindividuals with primary lymphedema may evenaffected limb while wearing compression is anotherbe skilled in self-bandaging; this can be performedcrucial component of CDT. The muscle pump achievedat nighttime in place of a foam-based orinside of the limb in addition to compression on theVELCRO garment.outer surface assists the lymphatic drainage and venous return.In the maintenance phase, individuals shouldFinally, all individuals affected by lymphedema shouldmaintain consistent daily use of compression, skinbe fitted with appropriate compression garments.care, self-manual lymphatic drainage, exercise, as well These garments are intended to maintain the progressas healthy eating and lifestyle habits. They should achieved in the decongestion phase of therapy and tocontinue regular follow up with their physician and prevent the progression of lymphedema. Compressionlymphedema therapist 59 . needs may vary from over-the-counter, circular knit garments to custom, flat knit garments. Individuals | Standardized Approach for the Diagnosis and Management of Lymphedema (LE) and Lymphatic Diseases (LD)|18'