Arterial Assist Intermittent Pneumatic Compression Generating Venous Obstruction with Retrograde Dilatation of Capillaries and Flow Improvement in the Long-Term Therapy of Ischemic Legs

Background: Patients with ischemia of lower limbs not suitable for surgical reconstruction of arteries can be treated with assist by intermittent pneumatic compression devices (IPC). Until recently 1-2 sec hit inflation pumps were used generating emptying veins and arterial-venous pressure gradient enabling greater arterial flow. To obtain better perfusion results we used a pump that, in contradiction to the “empty veins” devices, obstructed limb venous outflow by venous occlusions and in a long period therapy expanded perfusion vessels and brought about persistent reactive hyperemia. Aim: To check toe and calf arterial inflow measured by venous stasis plethysmography and capillary flow velocity during arterial assist IPC in a long-term therapy of ischemic legs. Material and methods: Eighteen patients (12M, 6F) age 62 to 75 with leg peripheral arterial disease (PAD, Fontaine II) were studied. Pneumatic device with two 10 cm wide cuffs (foot, calf) (Bio Compression Systems, Moonachie, NJ, USA) inflated to 120 mmHg for 5-6 sec to occlude the venous flow, deflation time 16 sec, applied for 45-60 min daily for a period of 2 years. Results: Increase in toe arterial pressure, volume, capillary blood flow velocity and one-minute arterial inflow test was observed. The two years therapy showed persistence of resting limb increased toe capillary flow. Intermittent claudication distance increased by 20-120%. After two years assist TBI increased from 0.2 to 0.6 (range 0.3 to 0.8) (p<0.05 vs pre-therapy). Conclusions: The crucial factor of rhythmic repeated venous outflow obstructions should be taken into account in designing effective assist devices.