EECP was initially developed in the United States, subsequently refined independently within the Chinese medical community, and has since gained widespread global use. As a non-invasive and painless modality of extracorporeal assisted circulation, EECP has been used for over three decades in the management of systemic ischemic diseases.The procedure is guided by the patient's electrocardiogram (ECG). During diastole, a series of inflatable cuffs applied to the calves, thighs, and buttocks are sequentially compressed in a distal-to-proximal order. This compression generates a hemodynamic wave that propels arterial blood from the periphery toward the aorta, establishing retrograde flow. Consequently, these hemodynamic changes improve perfusion to vital organs, including the heart and brain.Initially employed for the treatment of angina pectoris in patients with coronary heart disease, EECP has since seen its applications expand to include cardiac rehabilitation and other clinical areas:At present, its approved indications include cerebrovascular diseases, ophthalmic lesions, sudden sensorineural hearing loss, arteriosclerotic vascular occlusion, thromboangiitis obliterans (including cases with toe ulceration), peripheral circulatory disorders, peptic ulcers, viral hepatitis, and vascular erectile dysfunction, among others(9).This case represents the first reported instance of lower extremity lymphedema successfully managed with EECP. As an emerging adjunctive physical therapy, EECP offers a novel non-invasive approach for treating mild to moderate lymphedema, marking a significant expansion of its clinical applications into the domain of lymphatic rehabilitation.

The lymphatic circulation in the lower limbs is closely associated with the arteriovenous vasculature, with lymphatic vessels often coursing alongside veins. This anatomical proximity facilitates the return of lymph into the venous system. The interdependence between the lymphatic and blood vascular systems extends across anatomical structure, functional regulation, and pathophysiology, working in concert to maintain circulatory homeostasis and tissue fluid balance in the lower limbs. Extracorporeal counterpulsation therapy enhances arterial blood flow velocity and increases shear stress, thereby improving systemic arterial and venous circulation. This effect promotes peripheral blood flow and tissue perfusion, which in turn facilitates lymphatic return and circulation.As a result, it effectively alleviates symptoms of lower limb lymphedema and generalized edema in patients.In the state of lower extremity edema, the active contraction and peristaltic function of lymphatic vessels are often weakened. EECP can simulate the physiological effect of skeletal muscle pump through sequential and periodic inflation and deflation process, enhance the pressure generated by muscle contraction, and promote the contraction of smooth muscle in the wall of lymphatic vessels.This mechanism not only enhances the movement of interstitial fluid from the cellular spaces into the lymphatic vessels but also reduces capillary filtration, thereby improving lymphatic drainage into the venous system. Furthermore, by delivering sequential external compression from distal to proximal regions (calf → thigh → buttock), extracorporeal counterpulsation generates a contractile–relaxatory pressure gradient that mimics the physiological action of the skeletal muscle pump.The pressure waveform effectively simulates muscular contractions and the rhythmic contractions of smooth muscle in the lymphatic vessel wall. It aligns with the orientation of venous and lymphatic valves, promotes directional lymph flow, enhances lymphatic return efficiency, and thereby helps alleviate edema symptoms.Chronic lymphedema results in the accumulation of protein-rich lymph fluid within the tissues, stimulating fibrosis that manifests as tissue hardening and thickening—a pathological change that further impedes lymphatic drainage and creates a vicious cycle.By applying continuous, gentle mechanical pressure, extracorporeal counterpulsation softens and gradually breaks down fibrotic tissues, thereby reducing interstitial tension. This process facilitates the reopening and functional recovery of lymphatic vessels. Additionally, the therapy upregulates VEGF to induce neovascularization, thereby enhancing local fluid transport and absorption.Extracorporeal counterpulsation therapy can also effectively reduce the levels of key inflammatory factors such as tumor necrosis factor-α (TNF-α), monocyte chemotactic protein-1 (MCP-1) and hypersensitive C-reactive protein (hs-CRP) by regulating the body's pro-inflammatory mechanism, so as to inhibit oxidative stress and systemic inflammatory response.At the same time, it regulates vascular active substances, increases NO and endothelial progenitor cells, reduces ET-1, improves blood flow-mediated vasodilation function (FMD), and accelerates the transport of accumulated proteins, metabolic waste, bacteria and toxins in tissues to lymph nodes.This effect can help relieve local inflammation, reduce swelling, enhance oxygen supply and nutrition supply of local tissues, improve immune function, significantly reduce the risk of lower extremity lymphatic edema combined with infection, and has a certain preventive effect on the formation of deep vein thrombosis in lower extremities.

The precise setting of pressure parameters and the trigger timing for cuff inflation and deflation during extracorporeal counterpulsation pose significant challenges due to substantial inter-individual differences, such as variations in vascular elasticity and blood viscosity.This challenge is particularly prominent in patients with lower extremity lymphedema due to greater heterogeneity of their pathological status and physiological characteristics.Looking forward, the next generation of extracorporeal counterpulsation systems could generate individualized treatment plans for pressure and duration, tailored to patient-specific parameters such as edema severity, vascular elasticity, and blood viscosity, thereby enabling precise pressure management for lymphedema patients. This will improve the specificity and safety of treatment and play an important role in advancing the core technology of extracorporeal counterpulsation and expanding its range of clinical applications.