Acute oxygenation changes on ischemic foot of a novel intermittent pneumatic compression device and of an existing sequential device in severe peripheral arterial diseaseReportar como inadecuado




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BMC Cardiovascular Disorders

, 14:40

Hypertension and Cardiovascular Risk

Abstract

BackgroundIntermittent pneumatic compression IPC improves haemodynamics in peripheral arterial disease PAD, but its effects on foot perfusion were scarcely studied. In severe PAD patients we measured the foot oxygenation changes evoked by a novel intermittent IPC device GP, haemodynamics and compliance to the treatment. Reference values were obtained by a sequential foot-calf device SFC.

MethodsTwenty ischemic limbs Ankle-Brachial Index = 0.5 ± 0.2 of 12 PAD patients 7 male, age: 74.5 ± 10.8 y with an interval of 48 ± 2 hours received a 35 minute treatment in supine position with two IPC devices: i a Gradient Pump GP, which slowly inflates a single thigh special sleeve and ii an SFC ArtAssist, ACI Medical, San Marcos, CA, USA, which rapidly inflates two foot-calf sleeves. Main outcome measure: changes of oxygenated haemoglobin at foot HbO2foot by continuous near-infrared spectroscopy recording and quantified as area-under-curve AUC for periods of 5 minutes. Other measures: haemodynamics by echo-colour Doppler time average velocity TAV and blood flow BF in the popliteal artery and in the femoral vein, patient compliance by a properly developed form.

ResultsAll patients completed the treatment with GP, 9 with SFC. HbO2foot during the working phase, considered as average value of the 5 minutes periods, increased with GP AUC 458 ± 600 to 1216 ± 280 and decreased with SFC AUC 231 ± 946 to −1088 ± 346, significantly for most periods P < 0.05. The GP treatment was associated to significant haemodynamic changes from baseline to end of the treatment TAV = 10.2 ± 3.3 to 13.5 ± 5.5 cm-sec, P = 0.004; BF = 452.0 ± 187.2 to 607.9 ± 237.8 ml-sec, P = 0.0001, not observed with SFC TAV = 11.2 ± 3.4 to 11.8 ± 4.3 cm-sec; BF = 513.8 ± 203.7 to 505.9 ± 166.5 ml-min, P = n.s

GP obtained a higher score of patient compliance P < 0.0001.

ConclusionsA novel IPC thigh device, unlike a traditional SFC device, increased foot oxygenation in severe PAD, together with favourable haemodynamic response and high compliance to the treatment under the present experimental conditions.

KeywordsIntermittent pneumatic compression devices Near-infrared spectroscopy Peripheral vascular disease Perfusion Critical limb ischemia AbbreviationsAUCArea under curve

BFBlood flow

CLICritical limb ischemia

C phaseCompression phase

Cc phaseFull closing compression

Cp phaseEarly pushing compression phase

D phaseDecompression phase

HHbDeoxyhaemoglobin

GPGradient Pump

IPCIntermittent pneumatic compression

NIRSNear-infrared spectroscopy

O2HbOxyhaemoglobin

PADPeripheral arterial disease

SFCSequential foot-calf device

TAVTime average velocity

tHbTotal haemoglobin.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2261-14-40 contains supplementary material, which is available to authorized users.

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Autor: Fabio Manfredini - Anna Maria Malagoni - Michele Felisatti - Simona Mandini - Nicola Lamberti - Roberto Manfredini - France

Fuente: https://link.springer.com/article/10.1186/1471-2261-14-40







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