Malone MD, Cisek PL, Comerota AJ Jr, Holland B, Eid IG, Comerota AJ.
High-pressure, rapid-inflation pneumatic compression improves venous hemodynamics
in healthy volunteers and patients who are post-thrombotic.
J Vasc Surg 1999 Apr;29(4):593-9

Section of Vascular Surgery, Temple University Hospital, Department of
Biostatistics, Philadelphia, PA, USA.

PURPOSE: Deep vein thrombosis (DVT) is a preventable cause of morbidity and
mortality in patients who are hospitalized. An important part of the mechanism of
DVT prophylaxis with intermittent pneumatic compression (IPC) is reduced venous
stasis with increased velocity of venous return. The conventional methods of IPC
use low pressure and slow inflation of the air bladder on the leg to augment
venous return. Recently, compression devices have been designed that produce high
pressure and rapid inflation of air cuffs on the plantar plexus of the foot and
the calf. The purpose of this study is to evaluate the venous velocity response
to high-pressure, rapid-inflation compression devices versus standard,
low-pressure, slow-inflation compression devices in healthy volunteers and
patients with severe post-thrombotic venous disease. METHOD: Twenty-two lower
extremities from healthy volunteers and 11 lower extremities from patients with
class 4 to class 6 post-thrombotic chronic venous insufficiency were studied.
With duplex ultrasound scanning (ATL-Ultramark 9, Advanced Tech Laboratory,
Bothell, Wash), acute DVT was excluded before subject evaluation. Venous
velocities were monitored after the application of each of five IPC devices, with
all the patients in the supine position. Three high-pressure, rapid-compression
devices and two standard, low-pressure, slow-inflation compression devices were
applied in a random sequence. Maximal venous velocities were obtained at the
common femoral vein and the popliteal vein for all the devices and were recorded
as the mean peak velocity of three compression cycles and compared with baseline
velocities. RESULTS: The baseline venous velocities were higher in the femoral
veins than in the popliteal veins in both the volunteers and the post-thrombotic
subjects. Standard and high-pressure, rapid-inflation compression significantly
increased the popliteal and femoral vein velocities in healthy and
post-thrombotic subjects. High-pressure, rapid-inflation compression produced
significantly higher maximal venous velocities in the popliteal and femoral veins
in both healthy volunteers and patients who were post-thrombotic as compared with
standard compression. Compared with the healthy volunteers, the patients who were
post-thrombotic had a significantly attenuated velocity response at both the
popliteal and the femoral vein levels. CONCLUSION: High-pressure, rapid-inflation
pneumatic compression increases popliteal and femoral vein velocity as compared
with standard, low-pressure, slow-inflation pneumatic compression. Patients with
post-thrombotic venous disease have a compromised hemodynamic response to all IPC
devices. However, an increased velocity response to the high-pressure,
rapid-inflation compression device is preserved. High-pressure, rapid-inflation
pneumatic compression may offer additional protection from thrombotic
complications on the basis of an improved hemodynamic response, both in healthy
volunteers and in patients who were post-thrombotic.