Circulator boot therapy alters the natural history of ischemic limb ulceration

Despite numerous advances in interventional radiology and vascular surgery, the clinician continues to be confronted with inoperable Vascular disease. Previous studies have shown that ulceration associated with a transcutaneo us oxygen pressure (tcPO(2)) of <20 mmHg is refractory to all attempts at h ealing. External pneumatic compression for the treatment of peripheral vasc ular disease has been available for several years, although there is a rela tive paucity of data regarding its role in clinical practice as well as its efficacy. The objective of this study was to examine the experience with c irculator boot therapy in the treatment of ischemic ulcers in the absence o f osteomyelitis, and specifically to determine whether such therapy can be of benefit in ischemic limb ulceration associated with a tcPO(2) of <20 mmH g. A retrospective chart review was undertaken of all patients with a lower limb ulcer who, in the absence of osteomyelitis, underwent circulator boot therapy at the Gonda Vascular Center. A total of 98 patients was identifie d. Two patients died within 1 month of commencing therapy and were not incl uded in further analysis. The tcPO(2) data were unavailable in five patient s. Outcome in the patient population was classified as favorable if (1) hea ling was achieved, (2)the ulcer decreased in size, or (3) the affected limb improved sufficiently to allow successful revascularization. An unfavorabl e outcome was one where a major amputation was performed or where the ulcer increased in size. Out of a total of 29 patients with a tcPO(2) <20 mmHg a t the area of ulceration, 19 had a favorable outcome following circulator b oot therapy. Of the remaining 62 patients with a tcPO(2) >20 mmHg, 54 had a favorable outcome. Circulator boot therapy is associated with improved out comes in limb ulceration due to peripheral vascular disease. Complete ulcer healing as well as preservation of the affected limb can be achieved in mo st cases.