High-pressure, rapid-inflation pneumatic compression improves venous hemodynamics in healthy volunteers and patients who are post-thrombotic

Purpose:Deep vein thrombosis (DVT) is a preventable cause of morbidity and mortality in patients who are hospitalized. An important part of the mechan ism of DVT prophylaxis with intermittent pneumatic compression (IPC) is red uced venous stasis with increased velocity of venous return. The convention al methods of IPC use low pressure and slow inflation of the air bladder on the leg to augment venous return. Recently, compression devices have been designed that produce high pressure and rapid inflation of air cuffs on the plantar plexus of the foot and the calf. The purpose of this study is to e valuate the venous velocity response to high-pressure, rapid-inflation comp ression devices versus standard, low-pressure, slow-inflation compression d evices in healthy volunteers and patients with severe postthrombotic venous disease. Method: Twenty-two lower extremities from healthy volunteers and 11 lower e xtremities from patients with class 4 to class 6 post thrombotic chronic ve nous insufficiency were studied. With duplex ultrasound scanning (ATL-Ultra mark 9, Advanced Tech Laboratory, Bothell, Wash), acute DVT was excluded be fore subject evaluation. Venous velocities were monitored after the applica tion of each of five IPC devices, with all the patients in the supine posit ion. Three high-pressure, rapid-compression devices and two standard, low-p ressure, slow-inflation compression devices were applied in a random sequen ce. Maximal venous velocities were obtained at the common femoral vein and the popliteal vein for all the devices and were recorded as the mean peak v elocity of three compression cycles and compared with baseline velocities. Results:The baseline venous velocities were higher in the femoral veins tha n in the popliteal veins in both the volunteers and the post-thrombotic sub jects. Standard and high-pressure, rapid-inflation compression significantl y increased the popliteal and femoral vein velocities in healthy and post-t hrombotic subjects. High-pressure, rapid-inflation compression produced sig nifcantly higher maximal venous velocities in the popliteal and femoral vei ns in both healthy volunteers and patients who were post-thrombotic as comp ared with standard compression. Compared with the healthy volunteers, the p atients who were post-thrombotic had a significantly attenuated velocity re sponse at both the popliteal and the femoral vein levels. Conclusion: High-pressure, rapid-inflation pneumatic compression increases popliteal and femoral vein velocity as compared with standard, low-pressure , slow-inflation pneumatic compression. Patients with post-thrombotic venou s disease have a compromised hemodynamic response to all IPC devices. Howev er, an increased velocity response to the high-pressure, rapid-inflation co mpression device is preserved. High-pressure, rapid-inflation pneumatic com pression may offer additional protection from thrombotic complications on t he basis of an improved hemodynamic response, both in healthy volunteers an d in patients who were post-thrombotic.