The acute effects of intermittent pneumatic foot versus calf versus simultaneous foot and calf compression on popliteal artery hemodynamics: A comparative study

Introduction: Intermittent pneumatic compression (IPC) is currently being i nvestigated with respect to its effect on distal arterial volume flow in pa tients with peripheral vascular disease. Recently published data have shown a substantial acute enhancement in arterial calf inflow in response to IPC of the lower limb in both intermittent claudication and leg ischemia. Purpose: The aim of the study was to compare the immediate effects of inter mittent pneumatic foot (IPCfoot) versus calf (IPCcalf) versus simultaneous foot and calf compression (IPCfoot+calf) on popliteal artery hemodynamics i n patients with intermittent claudication (Fontaine II) and in normal subje cts, using duplex ultrasonography. For this purpose, 25 limbs of 20 healthy subjects (age range [mean], 51-74 [64] years) and 31 limbs of 25 claudican ts (age range [mean], 56-81 [66.5] years; resting ankle-brachial indices, 0 .38-0.75 [0.55]) were examined in the sitting position with and without IPC compression. Results: Mean popliteal artery flow in healthy subjects increased by 98.8% on application of IPCfoot, 188% with IPCcalf, and 274% with IPCfoot+calf (a ll P < .001). Mean flow in claudicants increased by 58% on application of I PCfoot, 132% with IPCcalf, and 174% with TPCfoot+calf (all P < .001). The m ean velocity, peak systolic velocity, and end diastolic velocity displayed a pattern of change similar to that for volume flow in both groups. Pulsati lity index decreased in both groups on application of IPC; the lowest value s were generated with IPCfoot+calf. Conclusion: Of the three compression modes investigated, IPCfoot+calf was t he most effective means of acutely augmenting: arterial calf inflow in arte riopaths and normals. The significant increase in end diastolic velocity an d decrease in pulsatility index indicate that peripheral vasodilatation is the central mechanism in this impulse-related flow augmentation. Prospectiv e trials are indicated to determine the clinical potential of the longterm effects of IPCfoot+calf in patients with symptomatic peripheral vascular di sease. (J Vasc Surg 2000;32:284-92.).