Delis KT, Slimani G, Hafez HM, Nicolaides AN.
Enhancing venous outflow in the lower limb with intermittent pneumatic
compression. A comparative haemodynamic analysis on the effect of foot vs. calf
vs. foot and calf compression.
Eur J Vasc Endovasc Surg 2000 Mar;19(3):250-60

Irvine Laboratory for Cardiovascular Investigation and Research, Academic
Vascular Unit, London, Paddington, UK.

OBJECTIVES: intermittent pneumatic compression (IPC), an established method of
deep-vein thrombosis prophylaxis, is also an effective means of leg inflow
enhancement, improving the walking capacity and ankle pressure of claudicants,
long-term. This study, using duplex ultrasonography, compares the haemodynamic
effect of IPC of the (a) foot (at 120 mmHg [IPC(foot/120 mmHg)], and 180 mmHg
[IPC(foot/180 mmHg)]), (b) calf (IPC(calf), 120 mmHg) and (c) both simultaneously
(IPC(foot+calf), 120 mmHg), on the venous outflow of 20 legs of normals and 25
legs of claudicants. RESULTS: the peak and mean velocities, volume flow and
pulsatility index in the superficial femoral and popliteal veins of both groups
increased significantly with all IPC modes (p<0.001). IPC(foot+calf)produced the
highest enhancement followed by IPC(calf)(p<0.01), which was more effective
(p<0.001) than either IPC(foot/180 mmHg)or IPC(foot/120 mmHg). The venous volume
expelled with IPC(calf)and IPC(foot+calf)was 2-2.5 and 3-3.5 times that with
IPC(foot/180 mmHg)respectively. Velocity enhancement with IPC was similar between
groups and the superficial femoral and popliteal veins. IPC(foot/180
mmHg)produced higher (p<0. 01) flow velocities than IPC(foot/120 mmHg)in both
groups and veins examined; however, differences were limited. CONCLUSIONS: all
IPC modes proved effective, IPC(foot+calf)generating the highest venous outflow
enhancement. Higher venous volumes expelled with IPC(foot+calf)explain its
reported superiority on leg inflow over the other modes. Increase of applied
pressure from 120 to 180 mmHg with IPC(foot)offered only a small outflow
improvement. Venous haemodynamics at rest and with IPC in claudicants do not
differ significantly from those in healthy subjects. Copyright 2000 Harcourt
Publishers Ltd.