Delis KT, Nicolaides AN, Wolfe JH, Stansby G.
Improving walking ability and ankle brachial pressure indices in symptomatic
peripheral vascular disease with intermittent pneumatic foot compression: a
prospective controlled study with one-year follow-up.
J Vasc Surg 2000 Apr ;31(4) :650-61

Irvine Laboratory for Cardiovascular Investigation and Research, Department of
Vascular Surgery, Imperial College School of Medicine, St Mary's Hospital,
London, UK.

PURPOSE: Intermittent pneumatic foot compression (IPC(foot)) augments arterial
leg inflow. It has been suggested that prolonged use of impulse leg compression
at home might ameliorate claudication caused by peripheral vascular disease by
improving collateral circulation. The purpose of this study was to determine the
effect of IPC(foot) treatment on claudication distance and arterial hemodynamics
in patients with intermittent claudication caused by peripheral vascular disease.
METHODS: Thirty-seven patients with stable intermittent claudication were
admitted to this prospective controlled study. Of these, 25 patients received
IPC(foot) (>4 hr/d) for 4.5 months (group 1), and the other 12 patients acted as
control patients (group 2). Both groups were advised to exercise unsupervised for
a minimum of 1 hour daily and received aspirin (75 mg/d). Groups were matched for
age, sex, risk factors, claudication distances, and ankle pressures at baseline.
In each patient, initial claudication distance (ICD), absolute claudication
distance (ACD), resting ankle brachial index (r-ABI), ankle brachial pressure
index after exercise (p-eABI), and popliteal artery volume flow were measured at
day 0, 2 weeks, and 1, 2, 3, and 4.5 months. On completion of the treatment
period (4.5 months), both groups continued with aspirin (75 mg/d) and
unsupervised exercise and were re-examined after 12 months. Data analysis is
based on nonparametric statistics, the Wilcoxon signed ranks test, and the
Mann-Whitney test for intragroup and intergroup comparisons, respectively.
Results are expressed as median and interquartile ranges. RESULTS: Over the 4.5
months of active treatment, (1) median ICD in group 1 increased by 146% (P
<.001), from 78 m (interquartile range, 65-102 m) at baseline to 191.5 m
(interquartile range, 127-254 m); ICD did not significantly increase in group 2;
(2) median ACD in group 1 improved by 106% (P <.001), from 124 m (interquartile
range, 100-160 m) to 255 m (interquartile range, 149-398 m); no significant
changes were documented in group 2; (3) median r-ABI in group 1 rose by 18% (P
<.001), from 0.57 (interquartile range, 0.48-0.62) to 0.67 (interquartile range,
0.64-0.70); no improvement was noted in group 2; (4) median p-eABI in group 1
rose by 110% (P <.001), from 0.21 (interquartile range, 0.07-0.27) to 0.44
(interquartile range, 0. 36-0.52); no changes were noted in group 2; and (5)
median popliteal artery volume flow in group 1 improved by 36% (P <.001), from
100 mL/min (interquartile range, 59-163 mL/min) to 136 mL/min (interquartile
range, 99.5-173.4 mL/min); no significant changes were found in group 2. At 4.5
months, ICD, ACD, r-ABI, and p-eABI in group 1 were all significantly better than
those in group 2 (P <.01). Twelve months' posttreatment, walking ability and ABIs
in group 1 were not statistically different from those at 4.5 months and remained
significantly better than those of control subjects. CONCLUSION: Intermittent
pneumatic foot compression used at home for 4.5 months increases claudication
distance by over 100%. Associated increases in r-ABI by 18%, p-eABI by 110%, and
arterial calf inflow by 36% suggest an improved collateral circulation. Maximum
benefit seems to be offered over the initial 3 months. Treatment benefits are
maintained 1 year after treatment. A multicenter study is indicated to quantify
actual benefits and to demonstrate cost effectiveness.