Delis KT, Nicolaides AN, Labropoulos N, Stansby G.
The acute effects of intermittent pneumatic foot versus calf versus simultaneous
foot and calf compression on popliteal artery hemodynamics: a comparative study.
J Vasc Surg 2000 Aug;32(2):284-92

Irvine Laboratory for Cardiovascular Investigation and Research, Imperial College
School of Medicine, Academic Vascular Surgery, St Mary's Hospital, Paddington,
United Kingdom.

INTRODUCTION: Intermittent pneumatic compression (IPC) is currently being
investigated with respect to its effect on distal arterial volume flow in
patients with peripheral vascular disease. Recently published data have shown a
substantial acute enhancement in arterial calf inflow in response to IPC of the
lower limb in both intermittent claudication and leg ischemia. PURPOSE: The aim
of the study was to compare the immediate effects of intermittent pneumatic foot
(IPC(foot)) versus calf (IPC(calf)) versus simultaneous foot and calf compression
(IPC(foot+calf)) on popliteal artery hemodynamics in patients with intermittent
claudication (Fontaine II) and in normal subjects, using duplex ultrasonography.
For this purpose, 25 limbs of 20 healthy subjects (age range [mean], 51-74 [64]
years) and 31 limbs of 25 claudicants (age range [mean], 56-81 [66.5] years;
resting ankle-brachial indices, 0.38-0.75 [0.55]) were examined in the sitting
position with and without IPC compression. RESULTS: Mean popliteal artery flow in
healthy subjects increased by 98.8% on application of IPC(foot), 188% with
IPC(calf), and 274% with IPC(foot+calf) (all P <.001). Mean flow in claudicants
increased by 58% on application of IPC(foot), 132% with IPC(calf), and 174% with
IPC(foot+calf) (all P <.001). The mean velocity, peak systolic velocity, and end
diastolic velocity displayed a pattern of change similar to that for volume flow
in both groups. Pulsatility index decreased in both groups on application of IPC;
the lowest values were generated with IPC(foot+calf). CONCLUSION: Of the three
compression modes investigated, IPC(foot+calf) was the most effective means of
acutely augmenting arterial calf inflow in arteriopaths and normals. The
significant increase in end diastolic velocity and decrease in pulsatility index
indicate that peripheral vasodilatation is the central mechanism in this
impulse-related flow augmentation. Prospective trials are indicated to determine
the clinical potential of the long-term effects of IPC(foot+calf) in patients
with symptomatic peripheral vascular disease.