Document Detail


High-pressure, rapid-inflation pneumatic compression improves venous hemodynamics in healthy volunteers and patients who are post-thrombotic.
MedLine Citation:
PMID:  10194485     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: Deep vein thrombosis (DVT) is a preventable cause of morbidity and mortality in patients who are hospitalized. An important part of the mechanism of DVT prophylaxis with intermittent pneumatic compression (IPC) is reduced venous stasis with increased velocity of venous return. The conventional methods of IPC use low pressure and slow inflation of the air bladder on the leg to augment venous return. Recently, compression devices have been designed that produce high pressure and rapid inflation of air cuffs on the plantar plexus of the foot and the calf. The purpose of this study is to evaluate the venous velocity response to high-pressure, rapid-inflation compression devices versus standard, low-pressure, slow-inflation compression devices in healthy volunteers and patients with severe post-thrombotic venous disease.
METHOD: Twenty-two lower extremities from healthy volunteers and 11 lower extremities from patients with class 4 to class 6 post-thrombotic chronic venous insufficiency were studied. With duplex ultrasound scanning (ATL-Ultramark 9, Advanced Tech Laboratory, Bothell, Wash), acute DVT was excluded before subject evaluation. Venous velocities were monitored after the application of each of five IPC devices, with all the patients in the supine position. Three high-pressure, rapid-compression devices and two standard, low-pressure, slow-inflation compression devices were applied in a random sequence. Maximal venous velocities were obtained at the common femoral vein and the popliteal vein for all the devices and were recorded as the mean peak velocity of three compression cycles and compared with baseline velocities.
RESULTS: The baseline venous velocities were higher in the femoral veins than in the popliteal veins in both the volunteers and the post-thrombotic subjects. Standard and high-pressure, rapid-inflation compression significantly increased the popliteal and femoral vein velocities in healthy and post-thrombotic subjects. High-pressure, rapid-inflation compression produced significantly higher maximal venous velocities in the popliteal and femoral veins in both healthy volunteers and patients who were post-thrombotic as compared with standard compression. Compared with the healthy volunteers, the patients who were post-thrombotic had a significantly attenuated velocity response at both the popliteal and the femoral vein levels.
CONCLUSION: High-pressure, rapid-inflation pneumatic compression increases popliteal and femoral vein velocity as compared with standard, low-pressure, slow-inflation pneumatic compression. Patients with post-thrombotic venous disease have a compromised hemodynamic response to all IPC devices. However, an increased velocity response to the high-pressure, rapid-inflation compression device is preserved. High-pressure, rapid-inflation pneumatic compression may offer additional protection from thrombotic complications on the basis of an improved hemodynamic response, both in healthy volunteers and in patients who were post-thrombotic.
Authors:
M D Malone; P L Cisek; A J Comerota; B Holland; I G Eid; A J Comerota
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Journal of vascular surgery     Volume:  29     ISSN:  0741-5214     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  1999 Apr 
Date Detail:
Created Date:  1999-05-05     Completed Date:  1999-05-05     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  593-9     Citation Subset:  IM    
Affiliation:
Section of Vascular Surgery, Temple University Hospital, Department of Biostatistics, Philadelphia, PA, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Bandages
Equipment and Supplies*
Femoral Vein / physiology
Hemodynamics
Humans
Leg
Popliteal Vein / physiology
Pressure
Treatment Outcome
Venous Thrombosis / physiopathology*,  prevention & control*,  ultrasonography
Grant Support
ID/Acronym/Agency:
MO1 RR00348/RR/NCRR NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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