Delis KT, Husmann MW, Cheshire NJ, Nicolaides AN.
Effects of intermittent pneumatic compression of the calf and thigh on arterial
calf inflow: a study of normals, claudicants, and grafted arteriopaths.
Surgery 2001 Feb;129(2):188-95

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

BACKGROUND: Recent data indicate that intermittent pneumatic compression (IPC) of
the foot may offer benefits in patients with intermittent claudication exceeding
those of standard medications approved by the Food and Drug Administration. IPC
of the foot (IPC(foot)) and calf (IPC(calf)) increases flow velocity in
infrainguinal arterial bypass grafts and thus may prevent arterial thrombosis.
Our aim was to evaluate the acute effects of IPC of the thigh (IPC(thigh)),
IPC(calf), and IPC of the thigh and calf (IPC(calf + thigh)) in healthy controls,
claudicants, and arteriopaths who have undergone infrainguinal bypass grafting
for critical or subcritical limb ischemia. METHODS: Sixteen limbs of normals
(group A), 17 limbs of claudicants (group B), and 16 limbs of arteriopaths (group
C) who had undergone infrainguinal autologous revascularization were studied.
Blood flow was measured in the limbs of normals and claudicants in the popliteal
artery and in the grafts of revascularized limbs by using duplex ultrasonography.
Mean velocity (mV), peak systolic velocity, end diastolic velocity (EDV),
pulsatility index (PI), and volume flow (Q) were measured in the sitting position
at rest and within 10 seconds from the delivery of IPC(thigh), IPC(calf), and
IPC(calf + thigh), IPC was delivered at maximum inflation and deflation pressures
of 120 mm Hg and 0 mm Hg, respectively; inflation and deflation times of 4 and 16
seconds, respectively; and a proximal inflate delay of 1 second (calf compression
preceding that of thigh). RESULTS: In all 3 groups with all IPC modes, the Q, mV,
and EDV increased while PI decreased (P <.05). IPC(thigh) was less effective than
IPC(calf), but still increased Q (by 114%, 57%, and 59.8% in groups A, B, and C,
respectively) and EDV, while decreasing PI in all 3 groups (P <.05). IPC(calf +
thigh) was the most efficient mode, generating an increase in the median Q of
424% in controls, 229% in claudicants, and 317% in grafted arteriopaths. The
addition of IPC(thigh) to IPC(calf) increased the mV and Q in group A (P < or =
.044); the mV, Q, and EDV in group B (P < or = .03), and mV and PI by 24% and
-27% in group C, respectively. CONCLUSIONS: IPC applied to the thigh, either
alone or in combination with IPC(calf), generates native arterial and
infrainguinal autologous graft flow enhancement. The paucity of conservative
methods available for lower limb blood flow augmentation may allow IPC of the
lower limb to emerge as a reliable, noninvasive therapeutic option, ameliorating
claudication and assisting infrainguinal bypass graft flow. IPC(thigh) adds to
the armamentarium of currently known IPC options (foot or calf) promoting its
applicability and efficacy.