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Limb Salvage Using High-Pressure Intermittent Compression Arterial Assist Device in Cases Unsuitable for Surgical Revascularization
Paul S. van Bemmelen, MD;
David B. Gitlitz, MD;
Rishad M. Faruqi, MD;
Joan Weiss-Olmanni, RVT;
Valerie A. Brunetti, DPM,FACFAS;
Fabio Giron, MD;
John J. Ricotta, MD
Arch Surg. 2001;136:1280-1285.
Hypothesis Intermittent compression therapy for patients with inoperable chronic critical ischemia with rest pain or tissue loss may have beneficial clinical and hemodynamic effects.
Study Design Case series of 14 consecutive ischemic legs that underwent application of a 3-month treatment protocol during a 2 -year study.
Setting Veterans Administration Hospital.
Patients Thirteen patients with 14 critically ischemic legs (rest pain, n = 14; tissue loss, n = 13) who were not candidates for surgical reconstruction were treated with rapid high-pressure intermittent compression. The patients had a mean age of 76.2 years, 8 were diabetic, and they represented 10% of referrals for chronic critical ischemia. They were not amenable to revascularization owing to lack of outflow arteries (n = 7), lack of autogenous vein (n = 5), or poor general medical condition (n = 3).
Intervention All patients were instructed to use the arterial assist device for 4 hours a day at home for a 3-month period.
Main Outcome Measures Limb salvage and calibrated pulse volume amplitude.
Results After 3 months, 9 legs had a significant increase in pulse-volume amplitude (P<.05). These legs were salvaged, whereas the 4 amputated legs demonstrated no hemodynamic improvement. We noted a direct correlation between patient compliance and clinical outcome. Patients in whom limb salvage was achieved used their compression device for longer periods of time (mean time, 2.38 hours a day) compared with those who underwent amputation (mean time, 1.14 hours a day) (P<.05). These mean hours of use were derived from an hour counter built into the compression units.
Conclusions Intermittent high-pressure compression may allow limb salvage in patients with limb-threatening ischemia who are not candidates for revascularization. Further studies are warranted to assess intermittent compression as an alternative to amputation in an increasingly older patient population.
From the Departments of Vascular Surgery (Drs van Bemmelen, Gitlitz, and Faruqi, and Ms Weiss-Olmanni) and Podiatry (Dr Brunetti), VA Medical Center, Northport, NY; and the Division of Vascular Surgery, State University of New York at Stony Brook (Drs van Bemmelen, Gitlitz, Faruqi, Giron, and Ricotta). Dr van Bemmelen has a patent agreement with ACI Medical Inc, San Marcos, Calif.
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