Vella A, Carlson LA, Blier B, Felty C, Kuiper JD, Rooke TW.
Circulator boot therapy alters the natural history of ischemic limb ulceration.
Vasc Med 2000;5(1):21-5

Department of Internal Medicine, Gonda Vascular Center, Rochester, MN 55905, USA.

Despite numerous advances in interventional radiology and vascular surgery, the
clinician continues to be confronted with inoperable vascular disease. Previous
studies have shown that ulceration associated with a transcutaneous oxygen
pressure (tcPO2) of <20 mmHg is refractory to all attempts at healing. External
pneumatic compression for the treatment of peripheral vascular disease has been
available for several years, although there is a relative paucity of data
regarding its role in clinical practice as well as its efficacy. The objective of
this study was to examine the experience with circulator boot therapy in the
treatment of ischemic ulcers in the absence of osteomyelitis, and specifically to
determine whether such therapy can be of benefit in ischemic limb ulceration
associated with a tcPO2 of <20 mmHg. A retrospective chart review was undertaken
of ail patients with a lower limb ulcer who, in the absence of osteomyelitis,
underwent circulator boot therapy at the Gonda Vascular Center. A total of 98
patients was identified. Two patients died within 1 month of commencing therapy
and were not included in further analysis. The tcPO2 data were unavailable in
five patients. Outcome in the patient population was classified as favorable if
(1)healing was achieved, (2)the ulcer decreased in size, or (3) the affected limb
improved sufficiently to allow successful revascularization. An unfavorable
outcome was one where a major amputation was performed or where the ulcer
increased in size. Out of a total of 29 patients with a tcPO2 <20 mmHg at the
area of ulceration, 19 had a favorable outcome following circulator boot therapy.
Of the remaining 62 patients with a tcPO2 >20 mmHg, 54 had a favorable outcome.
Circulator boot therapy is associated with improved outcomes in limb ulceration
due to peripheral vascular disease. Complete ulcer healing as well as
preservation of the affected limb can be achieved in most cases.