Arterial Assist Intermittent Pneumatic Compression Generating Venous Obstruction with Retrograde Dilatation of Capillaries and Flow Improvement in the Long-Term Therapy of Ischemic Legs

Waldemar Lech Olszewski

doi:10.35248/2329-6925.19.7.380

Abstract

Background: Patients with ischemia of lower limbs not suitable for surgical reconstruction of arteries can be treated with assist by intermittent pneumatic compression devices (IPC). Until recently 1-2 sec hit inflation pumps were used generating emptying veins and arterial-venous pressure gradient enabling greater arterial flow. To obtain better perfusion results we used a pump that, in contradiction to the “empty veins” devices, obstructed limb venous outflow by venous occlusions and in a long period therapy expanded perfusion vessels and brought about persistent reactive hyperemia. Aim: To check toe and calf arterial inflow measured by venous stasis plethysmography and capillary flow velocity during arterial assist IPC in a long-term therapy of ischemic legs. Material and methods: Eighteen patients (12M, 6F) age 62 to 75 with leg peripheral arterial disease (PAD, Fontaine II) were studied. Pneumatic device with two 10 cm wide cuffs (foot, calf) (Bio Compression Systems, Moonachie, NJ, USA) inflated to 120 mmHg for 5-6 sec to occlude the venous flow, deflation time 16 sec, applied for 45-60 min daily for a period of 2 years. Results: Increase in toe arterial pressure, volume, capillary blood flow velocity and one-minute arterial inflow test was observed. The two years therapy showed persistence of resting limb increased toe capillary flow. Intermittent claudication distance increased by 20-120%. After two years assist TBI increased from 0.2 to 0.6 (range 0.3 to 0.8) (p<0.05 vs pre-therapy). Conclusions: The crucial factor of rhythmic repeated venous outflow obstructions should be taken into account in designing effective assist devices.

Highlights

Ischemia of lower limbs due to atherosclerosis of arteries causing intermittent claudication, and in cases of more advanced state necrotic changes of peripheral tissues, concerns in the age group above 60 years between 1% and 7% of the population
In this study we investigated the mechanism of the designed arterial assist pump generating intermittent venous flow obstruction on the toe and calf arterial pulse, toe capillary flow velocity and arterial inflow volume as well as the intermittent claudication distance at two time points, after 1 hour and 2 years daily arterial flow assists
The pulse amplitude increased immediately after intermittent pneumatic compression devices (IPC) chambers inflation for 5-6 sec by 10-15 mmHg, before the inflating pressure reached 120 mmHg bringing about a 2 sec drop of arterial inflow and pressure (Figure 2)

Summary

Introduction

Ischemia of lower limbs due to atherosclerosis of arteries causing intermittent claudication, and in cases of more advanced state necrotic changes of peripheral tissues, concerns in the age group above 60 years between 1% and 7% of the population. There is a large group of patients with ischemia of the lower leg and foot without effect of the pharmacological treatment who are not eligible for surgical reconstruction of the arteries due to multi-segmental arterial occlusion and general contraindications for major surgery. The only treatment here is increasing blood peripheral tissue flow with the help of external support by intermittent pneumatic compression devices (IPC) [1]. Patients with ischemia of lower limbs not suitable for surgical reconstruction of arteries can be treated with assist by intermittent pneumatic compression devices (IPC). To obtain better perfusion results we used a pump that, in contradiction to the “empty veins” devices, obstructed limb venous outflow by venous occlusions and in a long period therapy expanded perfusion vessels and brought about persistent reactive hyperemia

Objectives

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Conclusion