A systematic review of intermittent pneumatic compression for critical limb ischaemia

Abstract

Intermittent pneumatic compression (IPC) is designed to aid wound healing and limb salvage for patients with critical limb ischaemia who are not candidates for revascularisation. We conducted a systematic review of the literature to identify and critically appraise the evidence supporting its use in this population. A search was conducted in Embase, MEDLINE and clinical trial registries up to the end of March 2013. No date or language restrictions were applied. Quality assessment was performed by two people independently. Quality was assessed using the Cochrane risk of bias tool and the NICE case-series assessment tool. Two controlled before-and-after (CBA) studies and six case series were identified. One retrospective CBA study involving compression of the calf reported improved limb salvage and wound healing (OR 7.00, 95% CI 1.82 to 26.89, p<0.01). One prospective CBA study involving sequential compression of the foot and calf reported statistically significant improvements in claudication distances and SF-36 quality of life scores. No difference in all-cause mortality was found. Complications included pain associated with compression, as well as skin abrasion and contact rash as a result of the cuff rubbing against the skin. All studies had a high risk of bias. In conclusion, the limited available results suggest that IPC may be associated with improved limb salvage, wound healing and pain management. However, in the absence of additional well-designed analytical studies examining the effect of IPC in critical limb ischaemia, this treatment remains unproven.

Guidelines on diagnosis, prognosis, and management of peripheral artery disease in patients with foot ulcers and diabetes (IWGDF 2019 update)

“…There are several other techniques that have been investigated for patients with diabetes, PAD, and ulceration in whom there are no options for revascularization. These include venous arterialization and intermittent pneumatic compression therapy . However, there are insufficient data to provide any recommendation on their utility in patients where no revascularization option exists.…”

“…These include venous arterialization and intermittent pneumatic compression therapy. 68,69 However, there are insufficient data to provide any recommendation on their utility in patients where no revascularization option exists.…”

Compression therapy for venous leg ulcers: risk factors for adverse events and complications, contraindications – a review of present guidelines

“…Inelastic short stretch bandages exert a massage effect during walking, which will reduce swelling and increase the blood flow. In a similar way, intermittent pneumatic pressure machines have been shown to increase arterial blood flow and to reveal beneficial clinical effects even in patients with symptomatic arterial occlusive disease …”

Usefulness of intermittent pneumatic compression in medicine

“…Despite unsatisfactory conclusions (low-quality evidence) drawn by two independent authors of systematic reviews [43,44] concerning IPC implementation in ischaemic legs, one should remember that there is no alternative therapy for patients who do not qualify for revascularization procedures and suffer from rest pain and/or ischaemic ulceration.…”

“…An undeniable benefit of IPC is the significant reduction in pain in these patients. Much evidence exists conforming the efficacy of IPC in the group of patients who have no surgical (revascularization) option [8, [43][44][45][46][47][48][49]. A variation of rubber calf therapy could be a plastic device -circulator boot [50,51].…”