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Venous and Lymphatic Interdependence: An Interview with Dr. Maldonado

Portrait of Dr. Thomas Maldonado

Dr. Maldonado is a renowned vascular surgeon and also serves as Koya Medical’s Chief Medical Officer.  He lives and practices medicine in New York City and is devoted to patient care and research.  In this interview, he tells us about the connection between the venous and lymphatic systems, and why early treatment is so important.


Why does your role as a vascular surgeon translate so well to your role at Koya Medical, which introduced Dayspring, the first non-pneumatic compression system?

Most people don’t realize how interdependent the vascular and lymphatic systems are. The most common form of secondary lymphedema in the US is called “Phlebolymphedema,” which is a combination of chronic venous insufficiency (CVI) and lymphatic insufficiency overloading one another’s ability to sufficiently move fluid, resulting in swelling. If left untreated, it’s a cycle of worsening conditions.


Explain a bit about CVI for those who might not be aware.

CVI occurs primarily in the lower extremities. When the veins are unable to sufficiently pump blood back up to the heart, blood pools in the lower legs. This pooling puts high pressure on the veins, which can cause fluid and proteins to filter out of the blood vessels and into the surrounding tissue.


What might cause the veins to be unable to return blood to the heart?

It could be caused by a weak calf muscle pump, damage to the veins, or the effects of aging. The calf muscle pump is often referred to as the body’s “second heart” and is a critical component to the health of both the venous and lymphatic systems. If it is weakened or underutilized, fluid isn’t returning to the heart as it should.


And this leads to swelling, or edema?

When this fluid filters out of the blood vessels, it becomes the job of the lymphatics to clear it and move it back upward out of the legs. The lymphatics can become quickly overwhelmed by the amount of fluid and can’t keep up. This causes the swelling.  If left untreated, the lymphatics get more and more overwhelmed and become permanently damaged.


What’s the general treatment you would recommend for a patient showing signs of phlebolymphedema?

Early treatment and intervention is key. “Conservative therapy”—compression, elevation, and exercise—is usually done first. Adjunctively, compression treatments such as Dayspring can be added when conservative therapy alone is not sufficient to halt disease progression.


How is Dayspring Non-Pneumatic Compression, different than other types of compression treatment?

Dayspring provides a unique level of clinical comprehensiveness that aligns with the key principles of conservative therapy. When patients add traditional pneumatic compression devices (PCDs) into their therapy, the very important component of exercise—the engagement of the venous and lymphatic systems—is lost since the patient must be supine and plugged into a wall. Like PCDs, Dayspring provides gradient sequential compression, but it goes beyond that to combine static compression, active compression, and muscle contractions (exercise) into one easy-to-use device. Battery powered Flexframes expand and contract sequentially instead of filling with air so that patients’ chronic edema is managed in a way that is aligned with the gold standard of care and also enables them to live their life without constraints on their mobility.

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