Ar. Eze et al., INTERMITTENT CALF AND FOOT COMPRESSION INCREASES LOWER-EXTREMITY BLOOD-FLOW, The American journal of surgery, 172(2), 1996, pp. 130-134
PURPOSE: Although foot compression increases foot skin perfusion and c
alf compression increases popliteal artery blood flow, these compressi
on techniques have not been evaluated in combination. The purpose of t
his study was to evaluate whether calf and foot compression applied se
parately and simultaneously increase popliteal artery blood flow and/o
r foot skin perfusion, and to assess the relative merits of compressio
n in patients with superficial femoral artery occlusion. METHODS: Twen
ty-two legs from 12 normal volunteers with ankle/brachial indices (ABI
s) >0.96, and 10 legs from 7 claudicator patients with angiographicall
y documented superficial femoral artery (SFA) occlusion and patent pop
liteal arteries with ABIs <0.8 were studied in the sitting positions.
Calf and foot cuffs connected to a rapidly inflating and deflating tim
ed-pressure pump (Art-Assist-AA 1000; ACI Medical Inc., San Marcos, Ca
lifornia) were applied to the subject in the sitting position. Skin bl
ood flow of the great toe was measured with a laser doppler (Laserflo
model BPM 403A; TSP Inc., St, Paul, Minnesota), and popliteal artery b
lood flow was measured using duplex ultrasonography (ATL-Ultramark 9;
Advanced Tech Laboratory, Bothell, Washington), Foot and card compress
ion was applied separately and simultaneously at 120 mm Hg pressure, w
ith a 10-second inflation and 20-second deflation cycle. Popliteal art
ery blood flow and foot skin perfusion were recorded and the mean of 6
cycles calculated. RESULTS: precompression popliteal artery blood blo
w (mL/min) for volunteers was 38.86 +/- 3.94, and for patients was 86.
30 +/- 14.55 (P = 0.001), Precompression foot skier perfusion (mL/min/
100/g tissue) for volunteers was 1.67 +/- 0.29, and for patients was
4.00 +/- 0.92 (P = 0.01). With the application of calf, foot, and simu
ltaneous calf and foot compression, the popliteal artery blood flow in
creased in volunteers by 124%, 54%, and 173%, respectively, and in pat
ients by 76%, 13%, and 50%. Foot skin perfusion increased in volunteer
s by 260%, 500%, and 328%, respectively, and in patients by 116%, 246%
, and 188%. Relative increases in popliteal artery blood flow and foot
skin perfusion were higher in volunteers compared with patients durin
g compression; however, the absolute values for foot skin perfusion an
d popliteal artery blood flow were consistently higher in patients. CO
NCLUSIONS: Measured in the sitting position, the resting popliteal art
ery blood flow and foot skin perfusion are greater in patients with SF
A occlusion compared with normal volunteers. Following compression, po
pliteal artery blood flow and foot skin perfusion increased in both gr
oups, but relatively more in volunteers, Increases in popliteal artery
blood flow are significantly higher with calf compression than with f
oot compression for both groups. A patent SFA allows for additive incr
eases in popliteal artery blood flow with simultaneous foot and calf c
ompression in normal persons, whereas this is not observed in patients
. However, the increases in foot skin perfusion in patients with an oc
cluded SFA parallel the increases shown in normal volunteers, with sep
arate and simultaneous foot and calf compression.