Background: Intermittent pneumatic compression (IPC) improves haemodynamics in peripheral arterial disease\r\n(PAD), but its effects on foot perfusion were scarcely studied. In severe PAD patients we measured the foot\r\noxygenation changes evoked by a novel intermittent IPC device (GP), haemodynamics and compliance to the\r\ntreatment. Reference values were obtained by a sequential foot-calf device (SFC).\r\nMethods: Twenty ischemic limbs (Ankle-Brachial Index = 0.5 �± 0.2) of 12 PAD patients (7 male, age: 74.5 �± 10.8 y)\r\nwith an interval of 48 �± 2 hours received a 35 minute treatment in supine position with two IPC devices: i) a\r\nGradient Pump (GP), which slowly inflates a single thigh special sleeve and ii) an SFC (ArtAssist�®, ACI Medical, San\r\nMarcos, CA, USA), which rapidly inflates two foot-calf sleeves. Main outcome measure: changes of oxygenated\r\nhaemoglobin at foot (HbO2foot) by continuous near-infrared spectroscopy recording and quantified as area-under-curve\r\n(AUC) for periods of 5 minutes. Other measures: haemodynamics by echo-colour Doppler (time average velocity (TAV)\r\nand blood flow (BF) in the popliteal artery and in the femoral vein), patient compliance by a properly developed form.\r\nResults: All patients completed the treatment with GP, 9 with SFC. HbO2foot during the working phase, considered as\r\naverage value of the 5 minutes periods, increased with GP (AUC 458 �± 600 to 1216 �± 280) and decreased with SFC\r\n(AUC 231 �± 946 to -1088 �± 346), significantly for most periods (P < 0.05). The GP treatment was associated to significant\r\nhaemodynamic changes from baseline to end of the treatment (TAV = 10.2 �± 3.3 to 13.5 �± 5.5 cm/sec, P = 0.004; BF =\r\n452.0 �± 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 =\r\n513.8 �± 203.7 to 505.9 �± 166.5 ml/min, P = n.s.). GP obtained a higher score of patient compliance (P < 0.0001).\r\nConclusions: A novel IPC thigh device, unlike a traditional SFC device, increased foot oxygenation in severe PAD,\r\ntogether with favourable haemodynamic response and high compliance to the treatment under the present\r\nexperimental conditions.
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