Abstract
BackgroundIn patients with critical leg ischemia (CLI), the standard operative choice is an in situ bypass to the lower extremity to improve the patients´ prognosis and quality of life. Postoperative complications after surgery occur in 18 % of the patients, prolonging hospitalization and convalescence. The main operative complication is edema. This can be prevented by early mobilization or stimulation of the natural venous pump in the leg.ObjectiveTo investigate whether compression therapy with foot pump reduces postoperative edema, facilitates wound healing of the operation wounds, promotes healing of ischemic ulcers, and shortens hospitalization, increasing and improving the patient’s subjective quality of life faster.MethodsThe protocol is designed as a randomized, unblinded prospective study with 50 patients in each group. Standard postoperative routines after bypass surgery, including short-stretch bandaging of the operated legs, are compared to supportive stimulation of the venous pump by an impulsive compression foot pump. The postoperative edema of the leg is measured 10 cm below the patella and 8 cm proximal to the medial malleolus. Measurements are performed preoperatively, 1 and 4 days postoperatively and at discharge.ResultsThe primary endpoint is reduction of leg edema by at least 50%. The secondary endpoint includes earlier mobilization in the pump group and decreased length of stay in hospital. Quality of life is evaluated through the European Health Related Quality of Life Questionnaire 5 Dimensions (EQ-5D) and Vascular Quality of Life Questionnaire-6 (VascuQol-6) questionnaires. The start of the study is February 1, 2018, and the end of the study is February 1, 2020. First results will be available April 2020.ConclusionsIn orthopedic surgery of the lower extremities, the use of foot pumps has shown a reduction of edema and thrombosis in risk patients. Although important positive effects may be expected after vein bypass surgery, no reports have yet investigated the use of the device in vascular-operated patients and no analysis or meta Cochrane reviews are available in this field.Trial RegistrationClinicalTrials.gov NCT03192982; https://clinicaltrials.gov/ct2/show/NCT03192982 (Archived by WebCite at http://www.webcitation.org/6xMZJ06dw)
Highlights
Critical leg ischemia (CLI) is a predominant cause of poor wound healing, leg amputation [1], and has a significant, negative impact on quality of life [2]
In patients with critical leg ischemia (CLI), the standard operative choice is an in situ bypass to the lower extremity to improve the patient's prognosis and quality of life
Postoperative edema can be prevented by early mobilization which stimulates the natural venous pump in the leg, but mobilization is often difficult in patients with CLI due to wound problems prior to surgery
Summary
Critical leg ischemia (CLI) is a predominant cause of poor wound healing, leg amputation [1], and has a significant, negative impact on quality of life [2]. In patients with critical leg ischemia (CLI), the standard operative choice is an in situ bypass to the lower extremity to improve the patientsprognosis and quality of life. This can be prevented by early mobilization or stimulation of the natural venous pump in the leg. In situ bypass to the lower extremity is the standard operation choice on patients with critical leg ischemia, accounting for approximately 18% of patients’ wound problems [11], prolonging their hospitalization time and convalescence. Stimulation of the venous plexus in the arch of the foot has, in other categories of patients, shown to reduce postoperative edema of leg and thrombosis risk in patients undergoing orthopedic surgery on the lower extremities. The patient can rapidly regain mobility and walking capability
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