THE MICROCIRCULATORY EFFECTS OF INTERMITTENT SEQUENTIAL COMPRESSION IN CHRONIC VENOUS HYPERTENSION

It has been observed that intermittent sequential compression (ISC) pr oduces an increase in the healing rate of venous leg ulcers. We assess ed the effects of ISC on the microcirculation of the skin in the media l perimalleolar region of patients with chronic venous hypertension (C VH) and skin changes (lipodermatosclerosis), and compared them to norm al control. Methods. Five groups of patients (total 72 patients, 78 Li mbs; mean age 46.2+/-5.0 (SEM)) with CVH and perimalleolar lipodermato sclerosis were studied. All had deep venous incompetence diagnosed wit h high ambulatory venous pressure(AVP >46 mmHg, mean: 63.6+/-1.9) and short refilling time (RT <12 seconds, mean: 6.7+/-0.3). Resting skin n ux (RF) was measured using a laser Doppler fluxmeter (LDF), in the sup ine position, and then while standing (SF) for 5 minutes. The venoarte riolar response - the vasoconstrictor response on standing - was calcu lated as VAR=100x(RF-SF)/(RF), Previous work has shown that in patient s with CVH and venous hypertensive microangiopathy RF is generally inc reased and the VAR may be altered. Four of the 5 patient groups were t reated with ISC, which was applied for 30 to 60 minutes with the patie nt supine, using a sequential compression device (Kendall SCDTM 5315). LDF was recorded before ISC, immediately after and up to 2 hours afte r cessation of ISC. The probe was placed at the perimalleolar region. Four comparable groups of normal subjects were similarly treated, and the remaining patient group served as untreated controls. Results. In all patients, baseline RF was increased and VAR was significantly dimi nished in comparison with normals. In treated patients, there was a si gnificant decrease in RF with ISC (p<0.02), which became evident after 10 minutes. The change in RF was still present and significant (p<0.0 2) up to 2 hours after the cessation of ISC. There was no change in RF or VAR in normal subjects or untreated patient controls. Conclusions. ISC produces a significant improvement of the microcirculation in ven ous hypertensive microangiopathy. These observations offer an explanat ion for the clinical effects of ISC on the healing of venous ulcers.