GUIDES

■ Use of intermittent pneumatic compression (IPC) devices have become an alternative treatment for patients unable to undergo angioplasty, open reconstruction, or without reconstruction options

■ IPC devices utilize sequential inflation and deflation compression pressure targeted to the affected limb

■ Mechanistic evaluation of IPC devices has revealed increased distal perfusion through increased popliteal, gastrocnemial, collateral arterial, and skin blood flow in patients with CLTI14

■ Evaluation with Doppler ultrasound identifies similar increases in both cutaneous and arterial perfusion following IPC use15-18

■ It has been postulated that IPC devices enhance blood flow through increasing the arteriovenous pressure gradient14

■ As blood is forced proximally out of the dependent foot and calf there is a reduction in the venous pressure19

■ Reduced venous pressure increases the arteriovenous pressure gradient augmenting arterial inflow20

■ The integrity of the arteriovenous pressure gradient is an important component of local vasoregulation via the venoarteriolar reflex (VAR) and has been shown to be impaired in patients with PAD. The VAR is an adaptive mechanism that creates venous distention, precapillary vasoconstriction, and subsequent decrease in capillary uptake in the sitting position21,22

■ As blood is moved proximally out of the dependent leg there is a decrease in venous pressure that allows precapillary sphincters to dilate again

■ Use of IPC devices has been found to temporarily suspend the VAR by increasing blood flow and temporarily abolishing postural vasoconstriction20

■ To summarize, proposed mechanisms for the effects of IPC include increased arteriovenous pressure gradient, stimulation of endothelial vasodilation, suspension of the VAR, and stimulation of collateral artery angiogenesis14,20,23

■ IPC devices are available as foot only, calf only, foot and calf, or foot, calf, and thigh. These devices utilize high pressure compression in the range of 80 - 140 mmHg with variable cycling each minute. IPC devices are typically prescribed to be used for 4 - 6 hours if CLTI has resulted in wounds, or rest pain is present24

■ A recent systematic review of available IPC devices found improvements in limb salvage, major adverse cardiovascular events, pain relief, quality of life, wound healing, and hemodynamics, varying by protocol and device used24