The acute effects of intermittent pneumatic foot versus calf versus simultaneous foot and calf compression on popliteal artery hemodynamics: A comparative study

Abstract

Introduction: Intermittent pneumatic compression (IPC) is currently being investigated with respect to its effect on distal arterial volume flow in patients with peripheral vascular disease. Recently published data have shown a substantial acute enhancement in arterial calf inflow in response to IPC of the lower limb in both intermittent claudication and leg ischemia. Purpose: The aim of the study was to compare the immediate effects of intermittent pneumatic foot (IPCfoot) versus calf (IPCcalf) versus simultaneous foot and calf compression (IPCfoot+calf) on popliteal artery hemodynamics in patients with intermittent claudication (Fontaine II) and in normal subjects, using duplex ultrasonography. For this purpose, 25 limbs of 20 healthy subjects (age range [mean], 51-74 [64] years) and 31 limbs of 25 claudicants (age range [mean], 56-81 [66.5] years; resting ankle-brachial indices, 0.38-0.75 [0.55]) were examined in the sitting position with and without IPC compression. Results: Mean popliteal artery flow in healthy subjects increased by 98.8% on application of IPCfoot, 188% with IPCcalf, and 274% with IPCfoot+calf (all P <.001). Mean flow in claudicants increased by 58% on application of IPCfoot, 132% with IPCcalf, and 174% with IPCfoot+calf (all P <.001). The mean velocity, peak systolic velocity, and end diastolic velocity displayed a pattern of change similar to that for volume flow in both groups. Pulsatility index decreased in both groups on application of IPC; the lowest values were generated with IPCfoot+calf. Conclusion: Of the three compression modes investigated, IPCfoot+calf was the most effective means of acutely augmenting arterial calf inflow in arteriopaths and normals. The significant increase in end diastolic velocity and decrease in pulsatility index indicate that peripheral vasodilatation is the central mechanism in this impulse-related flow augmentation. Prospective trials are indicated to determine the clinical potential of the long-term effects of IPCfoot+calf in patients with symptomatic peripheral vascular disease. (J Vasc Surg 2000;32:284-92.)