Effects of intermittent pneumatic compression of the calf and thigh on arterial calf inflow: A study of normals, claudicants, and grafted arteriopaths

Background. Recent data indicate that intermittent pneumatic compression (I PC) of the foot may offer benefits in patients with intermittent claudicati on exceeding those of standard medications approved by the Food and Drug Ad ministration. IPC of the foot (IPCfoot) and calf (IPCcalf) increases flow v elocity in infrainguinal arterial bypass grafts and thus may prevent arteri al thrombosis. Our main was to valuate the acute effects of IPC of the thig h (IPCthigh), IPCcalf, and IPC of the thigh and calf (IPCcalf+thigh) in hea lthy controls, claudicants,and arteriopaths who have undergone infrainguina l bypass grafting for critical or subcritical limb ischemia. Methods. Sixteen limbs of normals (group A), 17 limbs of claudicants (group B), and 16 limbs of arteriopaths (group C) who had undergone infrainguinal autologous revascularization were studied. Blood flow was measured in the limbs of normals and claudicants in the popliteal artery and in the grafts of revascularized limbs by using duplex ultrasonography. Mean velocity (mV) , peak systolic velocity, end diastolic velocity (EDV), pulsatility index ( PI), and volume flow (Q) were measured in the sitting position at rest and within 10 seconds from the delivery of IPCthigh, IPCcalf, and IPCcalf+thigh , IPC was delivered at maximum inflation and deflation pressures of 120 mm Hg and 0 mm Hg, respectively; inflation and deflation times of 4 and 16 sec onds, respectively; and a proximal inflate delay of 1 second (calf compress ion preceding that of thigh). Results. In all 3 groups with all IPC modes, the Q, mV, and EDV increased w hile PI decreased (P<.05), IPCthigh was less effective than IPCcalf, but st ill increased Q (by 114%, 57% and 59.8% in groups A, B, and C, respectively ) and EDV, while decreasing PI in all 3 groups (P<.05). IPCcalf+thigh was t he most efficient mode, generating an increase in the median Q of 424% in c ontrols, 229% in claudicants, and 317% in grafted arteriopaths. The additio n of IPCthigh to IPCcalf increased the mV and Q in group A (P less than or equal to .044); the mV, Q and EDV in group B (P less than or equal to .03), and mV and PI by 24% and -27% in group C, respectively. Conclusions. IPC applied to the thigh, either alone or in combination with IPCcalf generates native arterial and infrainguinal autologous graft flow e nhancement. The paucity of conservative methods available for lower limb bl ood flow augmentation may allow IPC of the lower limb to emerge as a reliab le, noninvasive therapeutic option, ameliorating claudication and assisting infrainguinal bypass graft flow. IPCthigh adds to the arrmamentarium of cu rrently known IPC options (foot or calf) promoting its applicability and ef ficacy.