Home use of impulse compression of the foot and compression stockings in the treatment of chronic venous insufficiency

Purpose: The use of intermittent pneumatic compression, in addition to elas tic bandages or stockings, accelerates the healing of leg ulcers in patient s with severe chronic venous insufficiency (M). There is recent evidence th at impulse compression of the plantar venous plexus reduces post-traumatic ankle swelling and prevents postoperative venous thromboembolism. The purpo se of this study was to evaluate the clinical and hemodynamic responses aft er home use of impulse foot compression for 3 months in patients already us ing therapeutic compression stockings for the management of M. Methods. Twelve extremities from 9 patients with documented CVI, class 4 to 5 according, to the Clinical, Etiology, Anatomy, Pathophysiology classific ation system, were included in this prospective cohort study. All patients were instructed to use a foot pump device at home for 2 hours a day for 3 m onths in addition to therapeutic compression stockings (30-40 min Hg) worn during, the day. The device was set to three cycles (3 seconds) of compress ion (120 mm Hg) per minute. A clinical scoring system was completed before foot compression and 1, 2, and 3 months thereafter. In addition, all patien ts underwent air plethysmography studies at the same time intervals, includ ing venous volume, venous filling index, ejection fraction, and residual vo lume fraction. Results: Patients reported significant improvement in their scores for swel ling (P < .05) and pain (P < .04). Air plethysmography showed a reduction i n venous volume and venous filling index, although these differences were n ot significant. Ejection fraction remained unchanged and residual volume fr action was significantly reduced (P < .05) compared with baseline. The foot compression devices were well tolerated by all the patients in the study. Conclusions. The use of home foot impulse compression plus elastic stocking s significantly reduced the residual volume fraction as measured by air-ple thysmography in a group of patients with severe CVI. This favorable hemodyn amic response could, in part, explain the clinical improvement achieved by this combined treatment. However, this represents a preliminary pilot study that needs to be confirmed in future randomized controlled studies with mo re patients included.