The use of intermittent pneumatic compression of the thigh to affect arterial and venous blood flow proximal to a chronic wound site

Rhys John Morris, Bethan Sarah Ridgway, John Patrick Woodcock, Rhys John Morris, Bethan Sarah Ridgway, John Patrick Woodcock

Abstract

Intermittent pneumatic compression of the lower limbs has been shown to have beneficial effects in patients with chronic ulceration. However, the intermittent compression cuff will normally be applied over the wound, which may produce discomfort or interfere with other treatments. Thigh-only approaches to intermittent pneumatic compression could solve this problem. This study aimed to demonstrate if such a system would have positive effects on venous and arterial blood flow distal to the compression site, but proximal to wound sites. The distal venous and arterial effects of a prototype thigh-only 3-chamber sequential intermittent pneumatic compression system were tested in 20 healthy volunteers, and 13 patients with ulcers of various aetiologies using Doppler ultrasound. The system produced hyperaemic responses in the arterial flow of both test groups. The peak venous velocity on deflation of the first and second chambers of the cuff was also greater in the patients with ulceration than in the healthy volunteers (11.6 cm/s vs 8.3 cm/s, P = .1). This work demonstrates that compression of the thigh alone can produce positive haemodynamic effects in the calves of patients with chronic wounds, and that this approach should be investigated as a therapy to improve blood flow to wound sites.

Keywords: arteries; hemodynamics; intermittent pneumatic compression devices; thigh; veins.

© 2020 The Authors. International Wound Journal published by Medicalhelplines.com Inc and John Wiley & Sons Ltd.

Figures

FIGURE 1
FIGURE 1
Cuff compression cycles
FIGURE 2
FIGURE 2
Normalised averaged distal arterial response for seven volunteers to Cycle 5
FIGURE 3
FIGURE 3
Normalised averaged distal arterial response for 20 volunteers to five 2‐minute applications of Cycle 5
FIGURE 4
FIGURE 4
Normalised averaged distal arterial response for seven patients with leg ulcers to five 2‐minute applications of Cycle 5
FIGURE 5
FIGURE 5
Effects on IPC of distal venous peak flow velocity in healthy volunteers and patients with leg ulcers

References

    1. Labropoulos N, Wierks C, Suffoletto B. Intermittent pneumatic compression for the treatment of lower extremity arterial disease: a systematic review. Vasc Med. 2002;7(2):141‐148.
    1. Moran PS, Teljeur C, Harrington P, Ryan M. A systematic review of intermittent pneumatic compression for critical limb ischaemia. Vasc Med. 2015;20(1):41‐50.
    1. Feldman JL, Stout NL, Wanchai A, Stewart BR, Cormier JN, Armer JM. Intermittent pneumatic compression therapy: a systematic review. Lymphology. 2012;45(1):13‐25.
    1. Zaleska M, Olszewski WL, Durlik M. The effectiveness of intermittent pneumatic compression in long‐term therapy of lymphedema of lower limbs. Lymphat Res Biol. 2014;12(2):103‐109.
    1. Tessari M, Tisato V, Rimondi E, Zamboni P, Malagoni AM. Effects of intermittent pneumatic compression treatment on clinical outcomes and biochemical markers in patients at low mobility with lower limb edema. J Vasc Surg Venous Lymphat Disord. 2018;6(4):500‐510.
    1. Nelson EA, Hillman A, Thomas K. Intermittent pneumatic compression for treating venous leg ulcers. Cochrane Database Syst Rev. 2014;5:CD001899.
    1. Arvesen K, Nielsen CB, Fogh K. Accelerated wound healing with combined NPWT and IPC: a case series. Br J Community Nurs. 2017;22(suppl 3):S41‐S45.
    1. Alvarez OM, Wendelken ME, Markowitz L, Comfort C. Effect of high‐pressure, intermittent pneumatic compression for the treatment of peripheral arterial disease and critical limb ischemia in patients without a surgical option. Wounds. 2015;27(11):293‐301.
    1. Comerota AJ. Intermittent pneumatic compression: physiologic and clinical basis to improve management of venous leg ulcers. J Vasc Surg. 2011;53(4):1121‐1129.
    1. Chen AH, Frangos SG, Kilaru S, Sumpio BE. Intermittent pneumatic compression devices ‐ physiological mechanisms of action. Eur J Vasc Endovasc Surg. 2001;21(5):383‐392.
    1. Morris RJ, Woodcock JP. Effects of supine intermittent compression on arterial inflow to the lower limb. Arch Surg. 2002;137(11):1269‐1273.
    1. Jockenhöfer F, Gollnick H, Herberger K, et al. Aetiology, comorbidities and cofactors of chronic leg ulcers: retrospective evaluation of 1000 patients from 10 specialised dermatological wound care centers in Germany. Int Wound J. 2016;13(5):821‐828.
    1. Shanmugam VK, Angra D, Rahimi H, McNish S. Vasculitic and autoimmune wounds. J Vasc Surg Venous Lymphat Disord. 2017;5(2):280‐292.
    1. O'Doherty B. Optimisation of intermittent compression for the improvement of vascular inflow and outflow proximal to a wound site [PhD thesis]. Cardiff: Cardiff University; 2008.
    1. Morris RJ, Woodcock JP. Intermittent venous compression, and the duration of hyperaemia in the common femoral artery. Clin Physiol Funct Imaging. 2004;24(4):237‐242.
    1. Sultan S, Hamada N, Soylu E, Fahy A, Hynes N, Tawfick W. Sequential compression biomechanical device in patients with critical limb ischemia and nonreconstructible peripheral vascular disease. J Vasc Surg. 2011;54(2):440‐446.
    1. Kalodiki E, Ellis M, Kakkos SK, Williams A, Davies AH, Geroulakos G. Immediate hemodynamic effect of the additional use of the SCD EXPRESS compression system in patients with venous ulcers treated with the four‐layer compression bandaging system. Eur J Vasc Endovasc Surg. 2007;33(4):483‐487.
    1. Morris RJ. Intermittent pneumatic compression ‐ systems and applications. J Med Eng Technol. 2008;32(3):179‐188.

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