The long-term arterial assist intermittent pneumatic compression generating venous flow obstruction is responsible for improvement of arterial flow in ischemic legs


Autoři: Marzanna T. Zaleska aff001;  Waldemar L. Olszewski aff002;  Jonathan Ross aff003
Působiště autorů: Department of Applied Physiology, Mossakowski Medical Research Center, Polish Academy of Sciences, Warsaw, Poland aff001;  Central Clinical Hospital, Ministry of Internal Affairs, Department of Surgery, Warsaw, Poland aff002;  Lehigh University, Philadelphia, PA, United States of America aff003
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
doi: 10.1371/journal.pone.0225950

Souhrn

Background

There is a large group of patients with ischemia of lower limbs not suitable for surgical reconstruction of arteries treated with the help of external assist by intermittent pneumatic compression devices (IPC). Until recently the generally accepted notion was that by compressing tissues below the knee, veins become emptied, venous pressure drops to zero and the increased arterial-venous pressure gradient enables greater arterial flow. We used a pump that, in contradiction to the “empty veins” devices, limited the limb venous outflow by venous obstructions and in a long period therapy expanded the perfusion vessels and brought about persistent reactive hyperemia.

Aim

To check the 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 stage II) were studied. Pneumatic device with two 10cm wide cuffs (foot, calf) (Bio Compression Systems, Moonachie, NJ, USA) inflated to 120 mmHg for 5–6 sec to obstruct the venous flow, deflation time 16 sec, applied for 45–60 min daily for a period of 2 years.

Results

At pump inflation increase in toe arterial pressure, volume, capillary blood flow velocity and one-minute arterial inflow test was observed. Increased toe volume appeared concomitantly with the inflated chamber venous obstruction. Resting pressure in the great saphenous vein increased. The two years therapy showed persistence of the resting limb increased toe capillary flow. Intermittent claudication distance increased by 20–120%. After two years arterial assist TBI increased from 0.2 to 0.6 (range 0.3 to 0.8) (p<0.05 vs pre-therapy). The toe arterial inflow dominated over that in calf skin and muscles, nevertheless, there was prolongation of the claudication distance presumably due to dilatation of exchange vessels also in muscles.

Conclusions

Our arterial assist IPC brought about increase in the toe capillary flow, long lasting dilatation of toe capillaries and extension of painless walking distance. The crucial factor of rhythmic repeated venous outflow obstructions should be taken into account in designing effective assist devices.

Klíčová slova:

Arteries – Blood flow – Blood pressure – Body limbs – Capillaries – Legs – Toes – Veins


Zdroje

1. Williams KJ, Babber A, Ravikumar R, Davies HK. (2016) Non-Invasive Management of Peripheral Arterial Disease. Adv Exp Med Biol—Advances in Internal Medicine 1: 387–406

2. Chen AH, Frangos SG, Kilaru S, Sumpio BE.(2001) Intermittent pneumatic compression devices—physiological mechanisms of action. Eur J Vasc Endovasc Surg. 21(5):383–92. doi: 10.1053/ejvs.2001.1348 11352511

3. Moran PS, Teljeur C, Harrington P, Ryan M. (2015) A systematic review of intermittent pneumatic compression for critical limb ischaemia Vascular Medicine 20(1): 41–50 doi: 10.1177/1358863X14552096 25270409

4. Van Bemmelen PS, Mattos MA, Faught WE, Mansour MA, Barkmeier LD, Hodgson KJ, et al.(1994) Augmentation of blood flow in limbs with occlusive arterial disease by intermittent calf compression. J Vasc Surg. 19:1052–1058. doi: 10.1016/s0741-5214(94)70217-9 8201706

5. Eze AR, Comerota AJ, Cisek PL, Holland BS, Kerr RP, Veeramasuneni R, et al.(1996) Intermittent calf and foot compression increases lower extremity blood flow. Am J Surg.172(2):130–4. doi: 10.1016/S0002-9610(96)00134-1 8795514

6. Van Bemmelen PS, Gitlitz DB, Faruqi RM, Weiss-Olmanni J, Brunetti VA, Giron F, et al (2001) Limb salvage using high-pressure intermittent compression arterial assist device in cases unsuitable for surgical revascularization. Arch Surg. 136 (11):1280–5 doi: 10.1001/archsurg.136.11.1280 11695973

7. Montori VM, Kavros SJ, Walsh EE, Rooke TW.(2002) Intermittent compression pump for nonhealing wounds in patients with limb ischemia. The Mayo Clinic experience (1998–2000). Int Angiol. 21(4):360–6. 12518117

8. Delis KT, Husmann MJ, Szendro G, Peters NS, Wolfe JH, Mansfield AO. (2004) Haemodynamic effect of intermittent pneumatic compression of the leg after infrainguinal arterial bypass grafting. Br J Surg. 91(4):429–34. doi: 10.1002/bjs.4482 15048742

9. Delis KT, Nicolaides AN, Labropoulos N, Stansby G. The acute effects of intermittent pneumatic foot versus calf versus simultaneous foot and calf compression on popliteal artery hemodynamics: a comparative study.(2000) J Vasc Surg. 32(2):284–92. doi: 10.1067/mva.2000.107570 10917988

10. Delis KT.(2005) The case for intermittent pneumatic compression of the lower extremity as a novel treatment in arterial claudication. Perspect Vasc Surg Endovasc Ther 17: 29–42. doi: 10.1177/153100350501700107 15952694

11. Husmann M, Willenberg T, Keo HH, Spring S, Kalodiki E, Delis KT.(2008) Integrity of venoarteriolar reflex determines level of microvascular skin flow enhancement with intermittent pneumatic compression. J Vasc Surg 48: 1509–1513. doi: 10.1016/j.jvs.2008.07.016 18829220

12. Labropoulos N, Leon LR Jr, Bhatti A, et al. (2005) Hemodynamic effects of intermittent pneumatic compression in patients with critical limb ischemia. J Vasc Surg 42: 710–716. doi: 10.1016/j.jvs.2005.05.051 16242559

13. Ramaswami G, D'Ayala M, Hollier LH, Deutsch R, McElhinney AJ.(2005) Rapid foot and calf compression increases walking distance in patients with intermittent claudication: results of a randomized study. J Vasc Surg. 41(5):794–801. doi: 10.1016/j.jvs.2005.01.045 15886663

14. Alvarez OM, Wendelken ME, Markowitz L, Comfort C.(2015)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. 27(11):293–301. 26574751

15. Martin JS, Borges AR, Beck DT.(2015) Peripheral conduit and resistance artery function are improved following a single, 1-h bout of peristaltic pulse external pneumatic compression. Eur J Appl Physiol.115(9):2019–29. doi: 10.1007/s00421-015-3187-8 25981709

16. Sutkowska E, Wozniewski M, Gamian A, GoskBierska I, Alexewicz P, Sutkowski K, et al. (2009) Intermittent pneumatic compression in stable claudicants: effect on hemostasis and endothelial function. Int Angiol 28: 373–379. 19935591

17. Rifkind JM, Nagababu E, Dobrosielski DA, Salgado MT, Lima M, Ouyang P, et al.(2014) The effect of intermittent pneumatic compression of legs on the levels of nitric oxide related species in blood and on arterial function in the arm.Nitric Oxide. 40:117–22 doi: 10.1016/j.niox.2014.06.007 24973574

18. Williams KJ, Moore HM, Davies AH. (2015) Haemodynamic changes with the use of neuromuscular electrical stimulation compared to intermittent pneumatic compression. Phlebology. 30(5):365–72. doi: 10.1177/0268355514531255 24722790

19. Sheldon RD, Roseguini BT, Laughlin MH, Newcomer SC. (2013) New insights into the physiologic basis for intermittent pneumatic limb compression as a therapeutic strategy for peripheral artery disease J Vasc.Surg 58: 1688–1696. doi: 10.1016/j.jvs.2013.08.094 24280329

20. Manfredini F, Malagoni AM, Felisatti M, Mandini S, Lamberti N, Manfredini R, et al. (2014) Acute oxygenation changes on ischemic foot of a novel intermittent pneumatic compression device and of an existing sequential device in severe peripheral arterial disease. BMC Cardiovasc Disord.31:14–40.

21. Ubbink DT, Jacobs JHM, Slaaf DW, Geert J, Tangelder WJM, Reneman RS. (1992) Capillary Recruitment and Pain Relief on Leg Dependency in Patients WithSevere Lower Limb Ischemia Circulation 85:223–229

22. Kawasaki T, Uemura T, Masumoto K, Harada J, Chuman T, Murat T. (2013) The effect of different positions on lower limbs skin perfusion pressure. Indian J Plast Surg. 46(3): 508–512 doi: 10.4103/0970-0358.121995 24459340

23. de Graaff JC, Ubbink DT, Lagarde SM, Jacobs MJHM.(2003) Postural changes in capillary pressure in the hallux of healthy volunteers.J Appl Physiol 95(6):2223–8. doi: 10.1152/japplphysiol.00210.2003 12871963

24. Acin F, Florez A, Bleda S, Fernandes LF.A prospective randomized controlled study with intermittent mechanical compression of the calf in patients with claudication. J Vasc Surg 2010;51:857–862 doi: 10.1016/j.jvs.2009.10.116 20347681

25. Van Bemmelen PS, Weiss-Olmanni J, Ricotta JJ.Rapid intermittent compression increases skin circulation in chronically ischemic legs with infrapopliteal arterial obstruction. Vasa 2000; 29:47–52 doi: 10.1024/0301-1526.29.1.47 10731888

26. de Graaff, Ubbink Th, van der Spruit JA, MD, Lagarde S, Jacobs. Influence of peripheral arterial disease on capillary pressure in the foot J Vasc Surg 2003;38:1067–74. doi: 10.1016/s0741-5214(03)00603-7 14603219

27. Burton AC. Physiology and Biophysics of the Circulation: An Introductory Text. Year Book Medical Publishers (New York), 1972, p.182.


Článek vyšel v časopise

PLOS One


2019 Číslo 12