Delis KT, Husmann MJ, Nicolaides AN, Wolfe JH, Chesire NJ.
Enhancing foot skin blood flux in peripheral vascular disease using intermittent
pneumatic compression: controlled study on claudicants and grafted arteriopaths.
World J Surg 2002 Jul;26(7):861-6
Irvine Laboratory, Academic Vascular Surgery, Imperial College School of
Medicine, St. Mary's Hospital, QEQM Wing 10th Floor, Praed Street, Paddington,
London W2 1NY, UK.
Intermittent pneumatic leg compression (IPC) increases arterial calf inflow and
foot skin blood flux in normal subjects and claudicants. Our hypothesis was that
IPC could enhance foot skin blood flux after infrainguinal grafting and thus
promote distal perfusion in limbs with tissue loss. The aim of this study was to
compare the effects of three IPC modes [applied to the foot (IPCfoot), the calf
(IPCcalf), or both (IPCfoot+calf)] on foot skin perfusion in healthy individuals,
claudicants, and patients after infrainguinal arterial revascularization
performed for critical or subcritical limb ischemia. Altogether, 20 healthy
limbs, 22 claudicating limbs, and 36 limbs of arteriopaths with prior successful
autologous femoropopliteal and femorodistal (18 each) grafts were examined.
Five-minute laser Doppler recordings were obtained from the pulp of the big toe
in the sitting position, at rest, and during random applications of IPCfoot,
IPCcalf, and IPCfoot+calf delivered at 120 mmHg for 4 seconds three times per
minute. Foot skin blood flux increased using all IPC modes (p <0.001), with
IPCfoot and IPCfoot+calf generating higher flux levels than IPCcalf (p <0.01) in
all groups. Intergroup differences of flux with each of the three IPC modes were
not significant. IPCfoot and IPCfoot+calf similarly (p > 0.14) produced a higher
percentage flux increase than IPCcalf in all groups (p <0.004). Controls had a
higher percentage flux increase with both IPCcalf and IPCfoot than did
claudicants (p? 0.016). No differences were documented between normal and grafted
limbs (p > 0.05). The percentage flux increase with IPCfoot+calf and IPCcalf was
significantly higher in femorodistal grafts than in femoropopliteal ones (p ?
0.026). IPC enhances skin blood flux in limbs with infrainguinal bypass,
claudication, and normal arteries, with IPCfoot and IPCfoot+calf being more
effective than IPCcalf. Our findings suggest that IPC may be beneficial in limbs
with impaired distal perfusion and thus may have clinical implications in the
treatment of leg ulcers either prior to or after revascularization.