Intermittent Sequential Compression Research Articles

A pilot study of venous flow augmentation using a novel mechanical graded intermittent sequential compression device for venous insufficiency

BackgroundGuidelines as well as multiple RTCs support the use of intermittent pneumatic compression (IPC) for the treatment of venous leg ulcers when conservative measures fail. Unfortunately, the clinical usefulness of IPC is significantly limited by the physical limitations of pneumatic motors, which leads to bulky devices with slow inflation cycles, uncomfortable sleeves, lack of patient mobility, and ultimately poor patient compliance with therapy. A novel mechanical device for lower leg graded intermittent sequential compression was designed to address these limitations of IPC therapy for venous leg ulcer treatment by providing rapid compression cycles in a truly wearable device that offers the additional benefit of monitoring compression dose and patient compliance. The wearable intermittent compression (WIC) device was hypothesized to provide improved augmentation of venous flow compared with both baseline and standard IPC therapy. MethodsTen patients with Clinical, Etiologic, Anatomic and Pathophysiologic class 3 to 6 venous insufficiency were recruited under institutional review board approval. The primary end point for the study was augmentation of venous blood flow as measured by peak venous velocity. Patients underwent measurement of peak venous velocity in centimeters per second at the popliteal and femoral veins for the following conditions: (1) baseline, (2) WIC device on a low setting, and (3) WIC device on a high setting. In five patients, an additional measurement of peak venous velocity in centimeters per second at the popliteal and femoral veins was completed while wearing a commercially available IPC device. ResultsBoth low and high settings of the WIC device resulted in higher average peak venous velocities when compared with both baseline and the IPC device (P < .05). No patients reported discomfort with either the WIC device or the IPC device during therapy. ConclusionsThe WIC device significantly increases the augmentation of venous flow as measured by peak venous velocity in both the popliteal and femoral veins in patients with Clinical, Etiologic, Anatomic and Pathophysiologic class 3 to 6 venous insufficiency. In addition, the WIC device was found to be easy to use and comfortable during therapy. Future studies are planned to determine if the WIC improvements in venous flow augmentation and patient compliance will lead to higher rates of venous ulcer healing.

Nonpneumatic Anti-Shock Garment versus Intermittent Sequential Compression Device for Prevention of Postspinal Hypotension in Patients Undergoing Cesarean Section: A Randomized Controlled Study.

Context:Postspinal hypotension remains a frequent complication of subarachnoid block during cesarean section causing further maternal and fetal adverse effects.Aims:This study aims to evaluate and compare a continuous pressure nonpneumatic anti-shock garment (NASG) and an intermittent sequential compression device (SCD) with a control group for prevention of postspinal hypotension in women undergoing elective cesarean section.Settings and Design:A randomized, observer blind, controlled study at single university hospital.Subjects and Methods:Ninety singleton term parturients between 18 and 35 years of age undergoing cesarean section with spinal anesthesia were randomly assigned to be applied with NASG, SCD, or no device; n = 30 in each group. A standardized protocol for cohydration and anesthetic technique was followed. The primary outcome measure was incidence of hypotension defined as a decrease in systolic blood pressure of more than 20% from baseline or an absolute value <100 mmHg, whichever was higher. The secondary outcome measures were median dose of ephedrine required, incidence of maternal nausea and vomiting, and neonatal Apgar scores.Statistical Analysis Used:Results were expressed as mean (±standard deviation), median (range), or number (%) as appropriate. Nominal data were compared using Chi-square/Fischer's exact test. Continuous data were compared using ANOVA one-way test. Nonparametric data were compared using Kruskal–Wallis test.Results:In Groups NASG, SCD, and C, incidence of hypotension was 60%, 83%, and 90%, respectively (P = 0.021), with significant reduction in incidence of hypotension in Group NASG versus Group C (P < 0.001, odds ratio 0.17, 95% confidence interval 0.04–0.68). Median (interquartile range) dose of ephedrine required was significantly less in Group NASG compared with Groups SCD and C, respectively (P = 0.002, P < 0.001).Conclusions:NASG proved to be a more effective device for prevention of postspinal hypotension when compared with application of SCD or no device.

PC212. Augmentation of Peak Venous Velocity in Venous Insufficiency Using a Novel Mechanical Intermittent Sequential Compression Device

PC212. Augmentation of Peak Venous Velocity in Venous Insufficiency Using a Novel Mechanical Intermittent Sequential Compression Device

Incidence of symptomatic venous thromboembolism in patients with hemophilia undergoing joint replacement surgery: A retrospective study

IntroductionVenous thromboembolism (VTE) is a recognized complication after joint replacement surgery, and prophylaxis is routinely used in patients without bleeding disorders. However, for patients with hemophilia, pharmacologic prophylaxis is highly variable and controversial because of the inherent bleeding risk. AimTo review our institutional experience with outcomes of total knee or hip arthroplasty with regard to symptomatic VTE and use of VTE prophylaxis in patients with hemophilia and without inhibitors. MethodsWe reviewed records of 42 consecutive patients with hemophilia A or B who underwent 71 hip or knee replacements over a 39-year period. We also reviewed the literature to estimate the incidence of VTE after arthroplasty in the hemophilia population. ResultsAll patients used compression stockings for up to 6weeks after surgery; additionally, 6 cases (10.5%; 57 with available data) used sequential intermittent compression devices and 2 (2.8%) postoperatively received low-molecular-weight heparin. One patient (1.4%) who received low-molecular-weight heparin had a symptomatic, lower-extremity, deep venous thrombosis 10days after hip replacement for traumatic fracture. None of the other 70 surgical cases had symptomatic VTE within 3months after the procedure. Analysis of pooled data from published series of hemophilia patients undergoing arthroplasty showed an estimated incidence of symptomatic VTE of 0.5%. ConclusionOur study suggests that in patients with hemophilia, joint replacement surgery can be performed safely without routine pharmacologic VTE prophylaxis and without increasing risk of thromboembolic events. Pharmacologic VTE prophylaxis may be considered in select patients with known additional risk factors for VTE.

Incidence Of Symptomatic Venous Thromboembolism In Patients With Hemophilia Undergoing Joint Replacement Surgery: A Retrospective Study

BackgroundHip and knee arthroplasty (THA and TKA), in general, pose a high risk for venous thromboembolism (VTE), and pharmacologic VTE prophylaxis is often strongly recommended. In patients (pt) with hemophilia undergoing THA/TKA, given the underlying bleeding diathesis, the routine use of pharmacologic VTE prophylaxis is controversial. In this study, we report THA/TKA outcomes in pt with hemophilia in our institution. MethodsRetrospective chart review of Mayo Comprehensive hemophilia center pt undergoing THA and TKA. Medical records were reviewed for objectively documented VTE for up to 3 months after surgery. Results42 consecutive pt with hemophilia A (n=38) or B (n=4) underwent 71 operations: THA (n=32) and TKA (n=39) over a period of 39 years. All pt received compression stockings up to 6 weeks after surgery; 6/71 (8.4%) received sequential intermittent compression and 2/71 (2.8%) received postoperative low molecular weight heparin (LMWH). Symptomatic femoral vein DVT occurred in 1/42 pt (2%); (1/71, 1.4% of operations (1.4%)), 10 days after THA for traumatic hip fracture and after the LMWH was discontinued. The patient was subsequently found to be heterozygous for the factor V Leiden gene mutation. For up to 3 months after surgery, there were no additional cases of symptomatic DVT. There was no unexpected bleeding in the 2 patients receiving LMWH. ConclusionIn this this study, routine use of compression stockings without the use of pharmacologic prophylaxis resulted in a low rate of symptomatic VTE in patients with hemophilia. This may be similar to the incidence in the general population receiving LMWH (Heit, JA et al Annals of Internal Medicine 2000) A limited sample size precludes definitive recommendations for practice. For appropriate high risk patients, limited use of pharmacologic prophylaxis may still be important. Disclosures:No relevant conflicts of interest to declare.

The Intermittent Sequential Compression Device on the Lower Extremities Attenuates the Decrease in Regional Cerebral Oxygen Saturation During Sitting Position Under Sevoflurane Anesthesia

The sitting position has potential for serious complications such as cerebral ischemia and venous air embolism. This study investigated the effects of intermittent sequential compression device (SCD) on the changes in regional cerebral oxygen saturation (rSO2) during the sitting position. Sixty-six healthy patients undergoing shoulder arthroscopy in sitting position were randomly assigned to either control (N = 33) or SCD (N = 33) groups. Hemodynamic variables and the rSO2 were measured 5 minutes after the induction of anesthesia (Tsupine, baseline values), and 1, 3, and 5 minutes after raising the patient to a 70-degree sitting position (T1, T3, and T5). The incidence of hypotension was recorded. The incidence of hypotension was significantly higher in the control group (8/33) than that in the SCD group (1/33) (P = 0.027, odds ratio 0.170, 95% CI 0.042-0.684). The rSO2 was significantly higher in the SCD group compared with those in the control group at T3 and T5. Within the group, rSO2 decreased significantly only in the control group compared with baseline value at T1, T3, and T5. The % change in rSO2 from T0 to T1, T3, and T5 were significantly lower in the SCD group compared to those in the control group. The application of SCD to the lower extremities during sitting position under sevoflurane anesthesia was a simple and effective method to attenuate the decrease in cerebral oxygen saturation.

Intermittent pneumatic sequential compression of the lower extremities restores the cerebral oxygen saturation during laparoscopic cholecystectomy

Pneumoperitoneum causes intracranial pressure elevation and blood stasis at lower extremities. This study investigates cerebral oxygen saturation changes during laparoscopy and the effects of intermittent sequential compression (ISC) of the lower extremities in patients during elective laparoscopic cholecystectomy. Sixty patients were randomly divided into two groups according to the application of ISC to the lower extremities. Group I served as control group whereas ISC was applied to group II. Cerebral oxygen saturation, peripheral blood oxygen saturation, heart rate, mean blood pressure, and associated changes have been recorded during the operation. Peripheral blood oxygen saturation and mean blood pressure values did not change significantly after pneumoperitoneum. Cerebral oxygen saturation levels of the group II patients were higher in than the group I patients and the difference between the groups was statistically significant (p = 0.0001). The difference became more prominent following the 35(th) minute of the operation. Mean heart rate of the patients in group II was lower than the patients in group I and the difference was also statistically significant (p = 0.0001). In this study, it was found that the decrease in cerebral oxygen saturation was recovered with ISC application. This simple and reliable technique helps to restore cerebral oxygen saturation levels while increasing blood return from the lower extremities.

Evidence-based compression: prevention of stasis and deep vein thrombosis.

To summarize the currently published scientific evidence for the venous flow effects of mechanical devices, particularly intermittent pneumatic compression, and the relation to prevention of deep vein thrombosis (DVT). While intermittent pneumatic compression is an established method of DVT prophylaxis, the variety of systems that are available can use very different compression techniques and sequences. In order for appropriate choices to be made to provide the optimum protection for patients, the general performance of systems, and physiological effects of particular properties, must be analyzed objectively. Medline was searched from 1970 to 2002, and all relevant papers were searched for further appropriate references. Papers were selected for inclusion when they addressed specifically the questions posed in this review. All the major types of intermittent compression systems are successful in emptying deep veins of the lower limb and preventing stasis in a variety of subject groups. Compression stockings appear to function more by preventing distension of veins. Rapid inflation, high pressures, and graded sequential intermittent compression systems will have particular augmentation profiles, but there is no evidence that such features improve the prophylactic ability of the system. The most important factors in selecting a mechanical prophylactic system, particularly during and after surgery, are patient compliance and the appropriateness of the site of compression. There is no evidence that the peak venous velocity produced by a system is a valid measure of medical performance.

Controlled evaluation of fibrinolytic response to intraoperative pneumatic intermittent sequential compression of the lower extremities during laparoscopic cholecystectomy

Objective: During a pneumoperitoneum intraoperative intermittent sequential pneumatic compression (ISC) neutralizes venous stasis in the lower extremities and may also have an influence on systemic fibrinolytic activity.Design: Controlled study to evaluate whether ISC stimulates intravascular fibrinolytic activity.Setting: University-Hospital.Materials: 26 patients underwent laparoscopic cholecystectomy with (+ISC, n = 10) or without (–ISC, n = 16) ISC.Intervention: Intraoperative intermittent sequential compression of the lower extremities.Main outcome measures: Major endpoint – postoperative plasma activity of tissue-plasminogen-activator (t-PA). Minor endpoints – postoperative plasminogen-activator-inhibitor-1 (PAl-1) activity, plasmin-antiplasmin-complex (PAP) concentration, concentration of total fibrin degradation products (TDP), and D-Dimer concentration.Results: There was no difference in age, sex, body mass index (BMI), and properative fibrinolytic activity between the groups. Postoperative t-PA-activity (P =0.3), PAI-1-activity (P =0.9), PAP- (P =0.5), TDP-(P =0.2), and D-Dimer-concentrations (P =0.1) were also not different between both groups.Conclusion: During laparoscopic cholecystectomy intraoperative ISC does not activate systemic intravascular fibrinolysis. Because of the positive hemodynamic effect of ISC during pneumoperitoneum, studies of the antithrombotic efficacy of this tool are needed in the setting of laparoscopic surgery.

Intermittent sequential compression of the lower limbs prevents venous stasis in laparoscopic and conventional colorectal surgery.

This study was designed to evaluate the influence of intraoperative intermittent sequential compression (ISC) on venous blood return from the lower limbs during laparoscopic and conventional colorectal colectomy. Fifty patients undergoing laparoscopic (n = 25) or conventional (n = 25) colorectal surgery were included in a prospective study. Peak venous flow (PFV) and the cross-sectional area (CSA) of the femoral vein were assessed by Doppler ultrasound examination intraoperatively. Age, gender, and body mass index were comparable between both groups. Baseline PFV was 21 +/- 6.6 cm/s in the conventional and 18.4 +/- 6.4 cm/s in the laparoscopic group (P = 0.2). ISC increased PFV to 156 +/- 29 percent of the baseline value in the conventional group and to 161 +/- 29 percent in the laparoscopic group. PFV decreased after abdominal insufflation to 127 +/- 19 percent of the baseline value in the laparoscopic group and after laparotomy to 134 +/- 27 percent in the conventional group (P = 0.3). PFV decreased slightly in both groups during surgery but remained well above the baseline value. Baseline CSA was 1.02 +/- 0.17 cm2 in the conventional group and 1 +/- 0.23 cm2 in the laparoscopic group. ISC decreased CSA to 0.91 +/- 0.18 cm2 (conventional) and 0.85 +/- 0.18 cm2 (laparoscopic) after initiation of ISC. CSA was 0.92 +/- 0.18 cm2 after abdominal insufflation in the laparoscopic group, and it was 0.93 +/- 0.18 cm2 after laparotomy in the conventional group (P = 0.4). During surgery, there were no differences in absolute CSA or CSA changes compared with the baseline value in both groups. Postoperative circumference of the calf and thigh were not different between both groups. Postoperative thromboembolic complications did not occur. ISC effectively increases venous blood flow from the lower limbs during conventional and laparoscopic colorectal resections and may decrease the risk of postoperative deep vein thrombosis. Therefore, ISC is strongly recommended in every prolonged laparoscopic procedure.

Effects of Intermittent Sequential Compression in Venous Hypertensive Microangiopathy

Objective: To investigate the acute effects of sequential compression on the microcirculation in limbs with chronic venous hypertension causing venous microangiopathy. Design: One group of patients with venous hypertension and a group of normal, comparable subjects were treated with intermittent sequential pneumatic compression applied for 30 min. Skin blood flow was measured by laser Doppler flowmetry at the perimalleolar region at rest (horizontal position) and on standing. The measurements were repeated at 0, 30 and 60 min after cessation of the compression. As criteria of inclusion, only limbs with high perimalleolar skin flux and decreased venoarteriolar response were included. Setting: St Mary's Hospital, London (teaching hospital). Patients, participants: Sixteen limbs in 16 patients with chronic venous hypertension and 12 limbs of comparable healthy volunteers were studied. Results: At rest, in the normal controls, the mean (SD) flux was 0.56 (0.3) units; it decreased on average by 35% on standing (venoarteriolar response). There was normal vasomotor activity. In patients, the mean flux was 1.45 (0.8) ( p &lt; 0.025) and the median venoarticular response only 7%. There was very limited vasomotor activity. Vasomotor activity started 10 min after the commencement of compression. At the end of the compression period there was a marked change towards normality. Resting flux was 0.90 (0.5) (significantly decreased) and the venoarteriolar response had increased to 23% ( p &lt; 0.025) with an improvement in vasomotor activity. These changes persisted at 30 and 60 min. Conclusions: The findings offer an explanation of the effect of sequential compression on the healing of leg ulcers in chronic venous insufficiency.

Venous thromboembolic disease.

During the past year, the findings of several clinical trials have been published that have important implications for the care of patients with venous thromboembolism. These clinical trials have produced advances in the diagnosis and treatment of venous thrombosis and pulmonary embolism and in the prevention of venous thromboembolism in high-risk patients. In patients with clinically suspected pulmonary embolism, the value and limitations of ventilation-perfusion lung scanning have been established, and it is now accepted that objective tests for deep vein thrombosis have an important role. There have been important advances also in the diagnosis of deep vein thrombosis; these advances include the finding that impedance plethysmography is effective in pregnant symptomatic patients and the development of an objective technique for Doppler ultrasound. The optimal duration of initial intravenous heparin treatment of established thrombosis has been determined. In the prevention of venous thromboembolism, the effectiveness of sequential intermittent compression in patients having hip replacement has been established, and further data on the effectiveness of low-molecular-weight heparin in high-risk patients have become available.

間欠的下し圧迫法による凝固線溶能の変動および血せん予防効果

Changes in platelet counts, prothrombin time, partial thromboplastin time, thrombo test, normo test (hepaplastin test), fibrinogen, euglobulin lysis time (ELT) and Bβ 15-42 peptide were investigated on 16 patients with benign disease and 27 with malignant disease before and after operation in general surgical patients. The same investigation was performed on 6 patients with benign disease and 29 with malignant disease who had intermittent sequential compression of the legs for 48 hours postoperatively.The 125I-fibrinogen uptake test was performed on 45 patients with malignant disease who had intermittent sequential compression of the legs for 48 hours postoperatively.Following results were obtained.1) It suggests that influence on activity of plasminogen activator was produced by leg compression but no influence on activity of plasmin and plasminogen was produced by leg compression.2) Incidence of deep vein thrombosis (DVT) in intermittent sequential leg compression group reduced to 8.9 per cent compared with 18.0 per cent in control group.

Intermittent sequential high-pressure compression of the leg: A new method of preventing deep vein thrombosis

The effect of sequential pneumatic leg compression on venous flow velocity was studied in 25 patients. At the usual pressures of 35 to 55 mm Hg, venous flow velocity was only 175 percent of the control value, but 366 percent when pressures were between 90 and 100 mm Hg. The incidence of postoperative thrombosis was studied in three groups of patients. In 24 patients receiving sequential compression prophylaxis of 90 to 100 mm Hg, there was one case of thrombosis, whereas there were three cases among the 25 patients with compression of 35 mm Hg and three cases among the 25 patients receiving 5,000 units of heparin three times per day. Sequential intermittent compression with high pressures, 10 compression cycles three times daily, is recommended for all patients unable to undertake physically active prophylactic measures. An absolute indication exists in those patients who cannot be mobilized and those in whom there are additional contraindications to the use of anticoagulants. Sequential compression is no alternative to antithrombosis stockings which must be worn from the day of hospitalization until discharge and also during the period of pneumatic compression.