Intermittent Venous Occlusion in Treatment of Peripheral Vascular Disease

Collens, William S.; Wilensky, Nathan D.

doi:10.1001/jama.1937.02780520015004

Cited by 23 publications

(5 citation statements)

References 3 publications

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“…The initial idea was that periods of compression of the veins result in the accumulation of metabolic products in tissue, and this would effect an increase in blood flow on release. [9][10][11] Cycles of increased flow over time would produce improvements in the peripheral circulation and healing of skin lesions. However, at the time, there were no direct noninvasive methods of measuring blood flow, and the method fell out of favor.…”

Section: Resultsmentioning

confidence: 99%

“…[5][6][7][8] The earliest use of the therapy, however, was in treating arterial insufficiency, with apparent improvement in intermittent claudication, rest pain, ulcers, and gangrene. [9][10][11] Anecdotal clinical evidence was not sufficient to gain the method widespread acceptance in recent times, although more objective observations and results have since been published. 12,13 In recent decades, investigations have also found that intermittent compression of the calf or foot can produce acute increases in arterial inflow to a limb.…”

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confidence: 99%

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Effects of Supine Intermittent Compression on Arterial Inflow to the Lower Limb

Morris¹

2002

Arch Surg

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Setting: Vascular ultrasound unit of a university hospital. Patients: A volunteer sample of 19 healthy subjects without symptoms or history of vascular disease and 17 patients with peripheral arterial disease were studied. Six patients and 1 healthy volunteer were not included in the study group because of measurement difficulties or refusal when approached. Interventions: Common femoral artery blood flow velocities were measured with Doppler ultrasound during 10 minutes of intermittent compression of the calf and thigh at 60 mm Hg, while the subject was supine. The data were collected every 5 seconds from 4 minutes before to 4 minutes after the therapy period, and toe temperatures were also measured with an infrared radiometer. Main Outcome Measures: Resting to postcompression percentage increases in flow velocity were measured, along with more representative measures of the total flow change during the intermittent compression period. Results: On compression, the blood flow velocity decreased slightly (15% in healthy subjects and 6% in patients) and increased on release (21% and 29%, respectively). Overall, blood flow did not decrease during therapy as expected (increases of 1% and 2%, respectively), and the toes of the patients warmed (by 2.2°C). Conclusions: This work confirms the initial hypothesis in both subject groups. There appears to be physiological justification for investigating intermittent compression as a therapy for patients with intermittent claudication and rest pain in the supine position as well as seated.

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Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

Effects of Supine Intermittent Compression on Arterial Inflow to the Lower Limb

Morris¹

2002

Arch Surg

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“…Thus, the compression-related transmural pressure reduction may set the stage for an adaptive myogenic vasodilatory response (Mellander et al, 1964;Henriksen, 1976;Nielsen, 1983). Further experimental evidence for this occurring locally in humans at external pressures between 10 and 30 mmHg has also been reported (Caro et al, 1970;Holloway et al, 1976;), and older reports describe therapeutic intermittent limb compression as a method of increasing arterial flow (Collens & Wilensky, 1937). More recent measurements of popliteal blood flow before and after intermittent calf compression also demonstrate a flow augmentation (Van Bemmelen et al, 1994), and a biphasic response to compression has been described (Walker et al, 1967).…”

Section: Possible Flow-augmentation Mechanismmentioning

confidence: 94%

Effects of compression bandaging on leg pulsatile blood flow

Mayrovitz

Larsen

1997

Clinical Physiology

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Leg external compression bandaging is the mainstay of venous ulcer treatment, yet little is known about the impact of therapeutic compression levels on arterial haemodynamics. In this study, the effect of foot-to-knee, four-layer compression bandaging on below-knee arterial pulsatile blood flow was assessed by nuclear magnetic resonance flowmetry. In 14 healthy supine subjects bilateral flow measurements at five below-knee sites without compression, and after compressing one leg to an average malleolar sub-bandage pressure of 40.7 +/- 4.0 mmHg, revealed a potentially important new phenomenon. The forefoot-to-knee compression bandaging caused a highly significant (P < 0.001) increase in the bandaged leg pulsatile blood flow owing to increases in both peak flow and pulse width. It is hypothesized that arteriolar vasodilatation, induced either myogenically by reduced transmural pressure or by vasodilatory substance release triggered by increased venous shear stress, produce the observed compression-related phenomenon. Whatever the mechanism(s), the finding of a compression-associated pulsatile flow increase suggests a previously undiscovered arterial linkage, which may play a role in the well-documented beneficial effects of compression bandaging in venous ulcer treatment. A possible impact of the arterial flow-pulse increase is speculated to effect venous ulcer outcome via a decrease in leucocyte effects in the distal microvasculature, as a consequence of the more vigorous haemodynamic state.

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“…Reports in the literature on the value of these methods are conflicting (6,10,43,44). While the former effect is highly desirable in a limb with acute ischemia, the latter effect is not, because it hampers the development of the collateral circulation.…”

Section: Conservative Methodsmentioning

confidence: 99%