Compression therapy for leg oedema in patients with heart failure

Tomasz Urbanek, Maciej Juśko, Wacław B Kuczmik, Tomasz Urbanek, Maciej Juśko, Wacław B Kuczmik

Abstract

The presence of chronic heart failure (CHF) results in a significant risk of leg oedema. Medical compression (MC) treatment is one of the basic methods of leg oedema elimination in patients with chronic venous disease and lymphedema, but it is not routinely considered in subjects with CHF-related swelling. In the study, an overview of the current knowledge related to the benefits and risk of using MC in the supportive treatment of leg oedema in CHF patients is presented. The available studies dedicated the comprehensive management of leg swelling using MC in CHF patients published in the English language literature till December 2019 were evaluated in term of the treatment efficacy and safety. In studies performed on CHF populations, manual lymphatic drainage, MC stocking, multilayer bandaged, as well as intermittent pneumatic compression or electric calf stimulations were used. The current evidence is based on non-randomized studies, small study cohorts, as well as very heterogenous populations. The use of the intermittent pneumatic compression in CHF patients significantly increases the right auricular pressure and mean pulmonary artery pressures as well as decreases systemic vascular resistance in most patients without the clinical worsening. The transient and rapid increase in the human atrial natriuretic peptide, after an application of the MC stocking in New York Heart Association (NYHA) class II patients was observed without clinical exacerbation. An application of the multilayer bandages in NYHA classes III and IV patients lead a significant increase in the right arterial pressure and lead to transient deterioration of the right and the left ventricular functions. In the manual lymphatic drainage study, aside from expected leg circumference reduction, no clinical worsening was observed. In a pilot study performed in a small cohort of CHF patients, electrical calf stimulation use resulted in a reduction in the lean mass of the legs without cardiac function worsening. The use of local leg compression can be considered stable CHF patients without decompensated heart function for both CHF-related oedema treatment and for treatment of the concomitant diseases leading to leg swelling occurrence. The use of MC in more severe classes of CHF (NYHA III and IV) should be the subject of future clinical studies to select the safest and most efficient compression method as well as to select the patients who benefit most from this kind of treatment.

Keywords: Heart failure; Leg swelling; Lymphedema; Medical compression.

© 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.

References

    1. Rabe E, Partsch H, Hafner J, Lattimer C, Mosti G, Neumann M, Urbanek T, Huebner M, Gaillard S, Carpentier P. Indications for medical compression stockings in venous and lymphatic disorders: an evidence‐based consensus statement. Phlebology 2018; 33: 163–184.
    1. Wittens C, Davies AH, Bækgaard N, Broholm R, Cavezzi A, Chastanet S, de Wolf M, Eggen C, Giannoukas A, Gohel M, Kakkos S, Lawson J, Noppeney T, Onida S, Pittaluga P, Thomis S, Toonder I, Vuylsteke M, Esvs Guidelines Committee, Kolh P, de Borst GJ, Chakfé N, Debus S, Hinchliffe R, Koncar I, Lindholt J, de Ceniga MV, Vermassen F, Verzini F, Document Reviewers, de Maeseneer MG, Blomgren L, Hartung O, Kalodiki E, Korten E, Lugli M, Naylor R, Nicolini P, Rosales A. Editor's choice‑management of chronic venous disease: clinical practice guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2015; 49: 678–737.
    1. Executive Committee . The diagnosis and treatment of peripheral lymphedema: 2016 consensus document of the International Society of Lymphology. Lymphology 2016; 49: 170–184.
    1. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González‐Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P, ESC Scientific Document Group . ESC Scientific Document Group. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 2016; 37: 2129–2200.
    1. Klima T, Drexler B, Balmelli C, Arenja N, Socrates T, Ringger R, Heinisch C, Ziller R, Schifferli J. Pathophysiology of lower extremity edema in acute heart failure revisited. Am J Med 2012; 125: 1124.e1–1124.e8.
    1. Schellong SM, Wollina U, Unger L, Machetanz J, Stelzner C. Leg swelling. Internist (Berl) 2013; 54: 1294–1303.
    1. Philipson H, Ekman I, Forslund HB, Swedberg K, Schaufelberger M. Salt and fluid restriction is effective in patients with chronic heart failure. Eur J Heart Fail 2013; 15: 1304–1310.
    1. O'Brien JG, Chennubhotla SA, Chennubhotla RV. Treatment of edema. Am Fam Physician 2005; 71: 2111–2117.
    1. Cooper KL. Care of the lower extremities in patients with acute decompensated heart failure. Crit Care Nurse 2011; 31: 21–29.
    1. The Criteria Committee for the New York Heart Association . Nomenclature and Criteria for Diagnosis of Diseases of the Heart and Great Vessels, Ninth ed. Boston: Little Brown and Company; 1994. p 253–256.
    1. Caraballo C. Clinical implications of the New York Heart Association classification. J Am H Associat 2019; 8: e014240.
    1. Blankfield RP, Finkelhor RS, Alexander JJ, Flocke SA, Maiocco J, Goodwin M, Zyzanski SJ. Etiology and diagnosis of bilateral leg edema in primary care. Am J Med 1998; 105: 192–197.
    1. Wrona M, Jöckel KH, Pannier F, Bock E, Hoffmann B, Rabe E. Association of venous disorders with leg symptoms: results from the Bonn Vein study 1. Eur J Vasc Endovasc Surg 2015; 50: 360–367.
    1. Jawien A. The influence of environmental factors in chronic venous insufficiency. Angiology 2003; 54: S19–S31.
    1. Kelder JC, Cramer MJ, van Wijngaarden J, van Tooren R, Mosterd A, Moons KGM, Lammers JW, Cowie MR, Grobbee DE, Hoes AW. The diagnostic value of physical examination and additional testing in primary care patients with suspected heart failure. Circulation 2011; 124: 2865–2873.
    1. Todd J, Austwick T, Berridge D, Tan LB, Barth JH. B‐type natriuretic peptice in lymphedema. Lymphology 2011; 44: 29–34.
    1. Kataoka H. clinical characteristics of lower‐extremity edema in stage A cardiovascular disease status defined by the ACC/AHA 2001 chronic heart failure guidelines. Clin Cardiol 2013; 36: 555–559.
    1. Hunt S, Baker DW, Chin MH, Cinquegrani MP, Feldman AM, Francis GS, Ganiats TG, Goldstein S, Gregoratos G, Jessup ML, Noble RJ, Packer M, Silver MA, Stevenson LW, Gibbons RJ, Antman EM, Alpert JS, Faxon DP, Fuster V, Gregoratos G, Jacobs AK, Hiratzka LF, Russell RO, Smith SC Jr, American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1995 Guidelines for the Evaluation and Management of Heart Failure) , International Society for Heart and Lung Transplantation , Heart Failure Society of America . ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult: executive summary a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee to Revise the 1995 Guidelines for the Evaluation and Management of Heart Failure). Circulation 2001; 104: 2996–3007.
    1. Ammar KA, Jacobsen SJ, Mahoney DW, Kors JA, Redfield MM, Burnett JC Jr, Rodeheffer RJ. Prevalence and prognostic significance of heart failure stages: application of the American College of Cardiology/American Heart Association Heart Failure Staging Criteria in the community. Circulation 2007; 115: 1563–1570.
    1. Mueller C, Frana B, Rodriguez D, Laule‐Kilian K, Perruchoud AP. Emergency diagnosis of congestive heart failure: impact of signs and symptoms. Can J Cardiol 2005; 21: 921–924.
    1. Nicolaides A, Kakkos S, Baekgaard N, Comerota A, de Maeseneer M, Eklof B, Giannoukas AD, Lugli M, Maleti O, Myers K, Nelzén O, Partsch H, Perrin M. Management of chronic venous disorders of the lower limbs. Guidelines according to scientific evidence. Part I. Int Angiol 2018; 37: 181–254.
    1. Augey F, Pinet A, Renaudier P. Heart failure and stasis ulcer: a significant association (prospective study of 100 cases). Ann Dermatol Venereol 2010; 137: 353–358.
    1. Kelly M, Gethin G. Prevalence of chronic illness and risk factors for chronic illness among patients with venous leg ulceration: a cross‐sectional study. Int J Low Extrem Wounds 2019; 18: 301–330.
    1. Rhou YJ, Henshaw FR, McGill MJ, Twigg SM. Congestive heart failure presence predicts delayed healing of foot ulcers in diabetes: an audit from a multidisciplinary high‐risk foot clinic. J Diabetes Complications 2015; 29: 556–562.
    1. Xu L, Qian H, Gu J, Shi J, Gu X, Tang Z. Heart failure in hospitalized patients with diabetic foot ulcers: clinical characteristics and their relationship with prognosis. J Diabetes 2013; 5: 429–438.
    1. Kataoka H. Clinical significance of bilateral leg edema and added value of monitoring weight gain during follow‐up of patients with established heart failure. ESC Heart Failure 2015; 2: 106–115.
    1. Andriessen A, Apelqvist J, Mosti G, Partsch H, Gonska C, Abel M. Compression therapy for venous leg ulcers: risk factors for adverse events and complications, contraindications–a review of present guidelines. J Eur Acad Dermatol Venereol 2017; 31: 1562–1568.
    1. Hirsch T. Oedema drainage and cardiac insufficiency–when is there a contraindication for compression and manual lymphatic drainage? Phlebologie 2018; 47: 115–119.
    1. McCardell CS, Berge KH, Ijaz M, Lanier WL. Acute pulmonary edema associated with placement of waist‐high, custom‐fit compression stockings. Mayo Clin Proc 1999; 74: 478–480.
    1. Dereppe H, Hoylaerts M, Renard M. Hemodynamic impact of pressotherapy. J Mal Vasc 1990; 15: 267–269.
    1. Galm O, Jansen‐Genzel W, von Helden J, Wienert V. Plasma human atrial natriuretic peptide under compression therapy in patients with chronic venous insufficiency with or without cardiac insufficiency. Vasa 1996; 25: 48–53.
    1. Tamura K. Intervention for varicose veins of lower extremities lowers the brain natriuretic peptide values in varicose vein patients. Ann Vasc Dis 2017; 10: 115–118.
    1. Bain RJ, Tan LB, Murray RG, Davies MK, Littler WA. Central hemodynamic changes during lower body positive pressure in patients with congestive cardiac failure. Cardiovasc Res 1989; 23: 833–837.
    1. Wilputte F, Renard M, Venner JP. Hemodynamic response to multilayered bandages dressed on a lower limb of patients with heart failure. Eur J Lym 2005; 15: 1–4.
    1. Alavi A, Sibbald RG, Phillips TJ, Miller OF, Margolis DJ, Marston W, Woo K, Romanelli M, Kirsner RS. What's new: management of venous leg ulcers: treating venous leg ulcers. J Am Acad Dermatol 2016; 74: 643–664.
    1. Nose Y, Murata K, Wada Y, Tanaka T, Fukagawa Y, Yoshino H, Susa T, Kihara C, Matsuzaki M. The impact of intermittent pneumatic compression devices on deep venous flow velocity in patients with congestive heart failure. J Cardiol 2010; 55: 384–390.
    1. Moady G, Bickel A, Shturman A, Khader M, Atar S. The safety and hemodynamic effects of pneumatic sleeves in patients with severe left ventricular dysfunction. Isr Med Assoc J 2019; 21: 649–652.
    1. Chen LE, Liu K, Qi WN, Joneschild E, Tan X, Seaber AV, Stamler JS, Urbaniak JR. Role of nitric oxide in vasodilation in upstream muscle during intermittent pneumatic compression. J Appl Physiol 2002; 92: 559–566.
    1. Dai G, Tsukurov O, Chen M, Gertler JP, Kamm RD. Endothelial nitric oxide production during in vitro simulation of external limb compression. Am J Physiol Heart Circ Physiol 2002; 282: H2066–H2075.
    1. Liu K, Chen LE, Seaber AV, Johnson GW, Urbaniak JR. Intermittent pneumatic compression of legs increases microcirculation in distant skeletal muscle. J Orthop Res 1999; 17: 88–95.
    1. Leduc O, Crasset V, Leleu C, Baptiste N, Koziel A, Delahaie C, Pastouret F, Wilputte F, Leduc A. Impact of manual lymphatic drainage on hemodynamic parameters in patients with heart failure and lower limb oedema. Lymphology 2011; 44: 13–20.
    1. Goddard AA, Pierce CS, McLeod KJ. Reversal of lower limb edema by calf muscle pump stimulation. J Cardiopulm Rehabil Prev 2008; 28: 174–179.
    1. Pierce C, McLeod KJ. Feasibility of treatment of lower limb edema with calf muscle pump stimulation in chronic heart failure. Eur J Cardiovasc Nurs 2009; 8: 345–348.
    1. Faghri PD, Van Meerdervort HF, Glaser RM, Figoni SF. Electrical stimulation‐induced contraction to reduce blood stasis during arthroplasty. IEEE Trans Rehabil Eng 1997; 5: 62–69.
    1. Vena D, Rubianto J, Popovic MR, Fernie GR, Yadollahi A. The effect of electrical stimulation of the calf muscle on leg fluid accumulation over a long period of sitting. Sci Rep 2017; 7: 6055.
    1. Abelmann WH, Fareeduddin K. Increased tolerance of orthostatic stress in patients with heart disease. Am J Cardiol 1969; 23: 353–363.
    1. Kubo SH, Cody RJ. Circulatory autoregulation in chronic congestive heart failure: responses to head‐up tilt in 41patients. Am J Cardiol 1983; 52: 512–518.
    1. Bronzwaer AS, Bogert L, Westerhof BE, Piek JJ, Daemen MJAP, van Lieshout J. Abnormal haemodynamic postural response in patients with chronic heart failure. ESC Heart Failure 2017; 4: 146–153.
    1. Gorelik O, Almoznino‐Sarafian D, Litvinov V, Alon I, Shteinshnaider M, Dotan E, Modai D, Cohen N. Seating‐induced postural hypotension is common in older patients with decompensated heart failure and may be prevented by lower limb compression bandaging. Gerontology 2009; 55: 138–144.
    1. Gorelik O, Feldman L, Cohen N. Heart failure and orthostatic hypotension. Heart Fail Rev 2016; 21: 529–538.
    1. Papismadov B, Tzur I, Izhakian S, Barchel D, Swarka M, Phatel H, Livshiz‐Riven I, Gorelik O. High compression leg bandaging prevents seated postural hypotension among elderly hospitalized patients. Geriatr Nurs 2019; 40: 558–564.

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa