Arcelus JI, Caprini JA, Sehgal LR, Reyna JJ.
Home use of impulse compression of the foot and compression stockings in the
treatment of chronic venous insufficiency.
J Vasc Surg 2001 Nov;34(5):805-11

Department of Surgery, Hospital de la Axarquia, Velez-Malaga, Spain.

PURPOSE: The use of intermittent pneumatic compression, in addition to elastic
bandages or stockings, accelerates the healing of leg ulcers in patients with
severe chronic venous insufficiency (CVI). There is recent evidence that impulse
compression of the plantar venous plexus reduces post-traumatic ankle swelling
and prevents postoperative venous thromboembolism. The purpose of this study was
to evaluate the clinical and hemodynamic responses after home use of impulse foot
compression for 3 months in patients already using therapeutic compression
stockings for the management of CVI. METHODS: Twelve extremities from 9 patients
with documented CVI, class 4 to 5 according to the Clinical, Etiology, Anatomy,
Pathophysiology classification system, were included in this prospective cohort
study. All patients were instructed to use a foot pump device at home for 2 hours
a day for 3 months in addition to therapeutic compression stockings (30-40 mm Hg)
worn during the day. The device was set to three cycles (3 seconds) of
compression (120 mm Hg) per minute. A clinical scoring system was completed
before foot compression and 1, 2, and 3 months thereafter. In addition, all
patients underwent air plethysmography studies at the same time intervals,
including venous volume, venous filling index, ejection fraction, and residual
volume fraction. RESULTS: Patients reported significant improvement in their
scores for swelling (P <.05) and pain (P <.04). Air plethysmography showed a
reduction in venous volume and venous filling index, although these differences
were not significant. Ejection fraction remained unchanged and residual volume
fraction was significantly reduced (P <.05) compared with baseline. The foot
compression devices were well tolerated by all the patients in the study.
CONCLUSIONS: The use of home foot impulse compression plus elastic stockings
significantly reduced the residual volume fraction as measured by
air-plethysmography in a group of patients with severe CVI. This favorable
hemodynamic response could, in part, explain the clinical improvement achieved by
this combined treatment. However, this represents a preliminary pilot study that
needs to be confirmed in future randomized controlled studies with more patients
included.