{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T07:06:02Z","timestamp":1789974362357,"version":"4.0.1"},"reference-count":23,"publisher":"Walter de Gruyter GmbH","issue":"10","license":[{"start":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T00:00:00Z","timestamp":1776297600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,22]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"j_jom-2025-0210_abs_001\">\n                    <jats:title>Context<\/jats:title>\n                    <jats:p>Chronic venous insufficiency (CVI) and peripheral arterial disease (PAD) are associated with significant morbidity, often manifesting as edema, pain, and nonhealing ulcers. Despite standard therapies such as compression, pharmacologic management, and surgical interventions, recurrence rates remain high, and outcomes are limited. Osteopathic manipulative medicine (OMM) lymphatic drainage techniques, including pedal pump maneuvers, aim to enhance venous return, reduce interstitial stasis, and improve overall vascular and lymphatic function. Such approaches may complement conventional therapies by addressing physiologic barriers to healing. Literature addressing OMM lymphatic drainage techniques in this population is sparse, creating a gap in evidence-based options for improving vascular and wound-healing outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_jom-2025-0210_abs_002\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The objective of this study is to systematically evaluate the evidence regarding the effectiveness of OMM lymphatic drainage techniques on wound healing, symptoms, and quality of life in patients with CVI and\u00a0PAD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_jom-2025-0210_abs_003\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic literature search was conducted to cover all available literature from database inception through January 20, 2024, with searches performed from February 26, 2023, to January 20, 2024, by four authors (IA, LS, ER, GNU). The databases searched included PubMed, World Health Organization (WHO) Global Health Library, Google Scholar, and ResearchGate. The keywords and Medical Subject Headings (MeSH terms) utilized were \u201clymphatic drainage,\u201d \u201cpedal pump,\u201d \u201cthoracic outlet,\u201d \u201cpelvic inlet,\u201d \u201cvenous insufficiency,\u201d \u201cperipheral arterial disease,\u201d \u201clower-leg ulcers,\u201d and \u201costeopathic manipulative medicine,\u201d combined with Boolean operators. Articles were included if they assessed OMM lymphatic drainage interventions in patients with CVI or PAD. Exclusion criteria were noninterventional design, lack of OMM focus, or irrelevance to PAD\/CVI. Screening followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines: duplicates were removed, titles and abstracts were screened, and disagreements among reviewers were resolved collectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_jom-2025-0210_abs_004\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 65 records were identified (PubMed=41, Google Scholar=12, ResearchGate=9, WHO=3). After removing duplicates, 32 remained; 27 were excluded following abstract screening, therefore five full-text articles were included. These consisted of one pilot case-control trial (n=30, PAD), one randomized controlled trial (n=20, immobile nursing home residents), one nonrandomized before-after community trial (n=8, lower-extremity ulcers), and two healthy-volunteer trials (n=17 and n=30). The reported outcomes included improvements in endothelial function, ankle\u2013brachial index, treadmill performance, wound surface area, leg volume, blood lactate clearance, and platelet count. Collectively, these studies suggest the physiologic and clinical benefits of OMM lymphatic drainage, although the small sample sizes and heterogeneous methodologies limit generalizability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_jom-2025-0210_abs_005\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Emerging evidence indicates that OMM lymphatic drainage techniques may provide meaningful physiologic and clinical benefits for patients with CVI and PAD. However, current studies are limited by small sample sizes, heterogeneity, and variable treatment protocols. Larger randomized controlled trials are needed to confirm the efficacy, establish standardized approaches, and clarify the role of lymphatic OMM in multidisciplinary vascular\u00a0care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1515\/jom-2025-0210","type":"journal-article","created":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T10:53:51Z","timestamp":1776682431000},"page":"491-497","source":"Crossref","is-referenced-by-count":0,"title":["Osteopathic manipulative medicine lymphatic drainage techniques for venous insufficiency and peripheral arterial disease: a review"],"prefix":"10.1515","volume":"126","author":[{"given":"Iya","family":"Agha","sequence":"first","affiliation":[{"name":"Department of Dermatology, Larkin Community Hospital , South Miami , FL , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lyudmyla","family":"Susla","sequence":"additional","affiliation":[{"name":"New York Institute of Technology College of Osteopathic Medicine , Old Westbury , NY , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Ryder","sequence":"additional","affiliation":[{"name":"Department of Family Medicine , HCA Florida Orange Park Hospital , Orange Park , FL , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gursimran Nanki","family":"Udhwani","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Larkin Community Hospital , South Miami , FL , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-8331-9428","authenticated-orcid":false,"given":"Sheldon C.","family":"Yao","sequence":"additional","affiliation":[{"name":"Department of Osteopathic Manipulative Medicine , New York Institute of Technology , Old Westbury , NY , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2026,4,16]]},"reference":[{"key":"2026092106580039605_j_jom-2025-0210_ref_001","doi-asserted-by":"crossref","unstructured":"Golledge, J, Drovandi, A. Evidence-based recommendations for medical management of peripheral artery disease. J\u00a0Atheroscler Thromb 2021;28:573\u201383. https:\/\/doi.org\/10.5551\/jat.62778.","DOI":"10.5551\/jat.62778"},{"key":"2026092106580039605_j_jom-2025-0210_ref_002","doi-asserted-by":"crossref","unstructured":"Aday, AW, Matsushita, K. Epidemiology of peripheral artery disease and polyvascular disease. Circ Res 2021;128:1818\u201332. https:\/\/doi.org\/10.1161\/CIRCRESAHA.121.318535.","DOI":"10.1161\/CIRCRESAHA.121.318535"},{"key":"2026092106580039605_j_jom-2025-0210_ref_003","doi-asserted-by":"crossref","unstructured":"Kansal, A, Davis, AM, Rymer, JA. Management of peripheral artery disease. 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Treasure Island (FL): StatPearls Publishing; 2025. Available from: https:\/\/www-ncbi-nlm-nih-gov.nyit.idm.oclc.org\/books\/NBK430975\/."},{"key":"2026092106580039605_j_jom-2025-0210_ref_007","unstructured":"Campbell, SM, Winkelmann, RR, Walkowski, S. Osteopathic manipulative treatment: novel application to dermatological disease. J\u00a0Clin Aesthet Dermatol 2012;5:24\u201332."},{"key":"2026092106580039605_j_jom-2025-0210_ref_008","doi-asserted-by":"crossref","unstructured":"Cicchitti, L, Martelli, M, Cerritelli, F. Chronic inflammatory disease and osteopathy: a systematic review. PLoS One 2015;10:e0121327. https:\/\/doi.org\/10.1371\/journal.pone.0121327.","DOI":"10.1371\/journal.pone.0121327"},{"key":"2026092106580039605_j_jom-2025-0210_ref_009","doi-asserted-by":"crossref","unstructured":"Lombardini, R, Marchesi, S, Collebrusco, L, Vaudo, G, Pasqualini, L, Ciuffetti, G, et al.. 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