Berliner E, Ozbilgin B, Zarin DA.
A systematic review of pneumatic compression for treatment of chronic venous
insufficiency and venous ulcers.
J Vasc Surg 2003 Mar;37(3):539-44

Center for Practice and Technology Assessment, Agency for Healthcare Research and
Quality/NIH, 6010 Executive Boulevard, Suite 300, Rockville, MD 20852, USA.
eberline@ahrq.gov

INTRODUCTION: As part of a reconsideration of coverage policy, the Centers for
Medicare and Medicaid Services requested a systematic review of the evidence on
the use of pneumatic compression devices in the home environment for treatment of
chronic venous insufficiency (CVI) and venous ulcers. METHODS: Articles were
found with a systematic literature search of MEDLINE, EMBASE, and AMED (Allied
and Complementary Medicine) databases, hand searches of reference lists, and
suggestions of experts. RESULTS: Eight trials that met the inclusion criteria,
including several randomized control trials, were found. Most studies were small
and may have been underpowered. However, several were well-designed randomized
controlled trials. Three studies showed that the devices could alleviate symptoms
of CVI. No studies directly measured whether the devices could prevent the
occurrence of venous ulcers. Some studies on the treatment of venous ulcers did
not show a benefit for pneumatic compression, but other studies showed a benefit
for the devices in healing long-standing chronic ulcers that had not healed with
other methods. No studies directly compared single-chamber and multiple-chamber
devices or studied whether the effectiveness of the pump was dependent on types
of treatment used concurrently with the pump. Few adverse events were reported in
the trials. Patients generally expressed satisfaction with the pneumatic
compression devices, and several studies reported higher compliance than with
other compression methods. CONCLUSION: The available data cannot be relied on to
inform the optimal choice of compression therapy or optimal protocol for patients
with CVI or venous ulcers. Methodologically rigorous research designed to answer
these questions would be useful for treatment decisions. The Centers for Medicare
and Medicaid Services considered the results of this study and issued a decision
that pneumatic compression will only be covered for patients with refractory
edema with significant ulceration of the lower extremities after a 6-month trial
of standard therapies, such as compression stockings, has failed.