Critical Limb Ischemia Management With Intermittent Pneumatic Compression

Purpose:
End-stage critical limb ischemia resulting in rest pain and non-healing wounds remains a complex dilemma in wound care clinics and limb salvage programs when all standard of care treatment modalities have been exhausted. Given the increasing incidence of diabetes mellitus, metabolic syndrome and advancing societal age, lower extremity amputation rates have continued to increase over the past decade despite significant technological and medical advances. The purpose of this poster is to review 2 cases of limb salvage using intermittent arterial pneumatic compression, provide an overview of peer reviewed published data with respect to intermittent arterial pneumatic compression and present a theory regarding microvascular perfusion enhancement thru stimulation of the glycocalyx resulting in eNOS activation and enhanced eNO production with use of intermittent pneumatic compression.

Material and Methods:
2 cases of lower extremity limb salvage with use of intermittent pneumatic compression are presented to showcase the benefit and optimal management of end-stage critical limb ischemia to prevent lower extremity amputation. A review of published data was undertaken of intermittent arterial pneumatic compression. A review of published data was undertaken of the microvascular glycocalyx, eNOS activation pathways and enhanced eNO production

Results:
An up to date review of peer reviewed published data is provided regarding the role and benefit for intermittent pneumatic compression to improve lower extremity limb salvage, as a treatment option in complex and advanced wound care and critical limb ischemia programs. A theory regarding the microvascular enhancement of oxygen and nutrient delivery thru intermittent pneumatic arterial pump utilization is proposed incorporating the glycocalyx, eNOS activation and enhanced eNO production.

Conclusions:
Intermittent pneumatic compression for wound healing and relief of rest pain is not currently reimbursed by the Centers for Medicare &Medicaid Services (CMS) or most third-party payers. Given the increasing rates of lower extremity amputation over the past decade despite significant advances in procedural, technical and medical options, intermittent pneumatic pump utilization has the potential and peer reviewed data to support routine use within a standard of care algorithm to improve patient cares, outcomes and quality of life as a cost effective and durable treatment modality.