Arterial Pneumatic Support Improves Ischemic Tissue Perfusion and Ulcer Healing

Background: Arterial obstructing plaques develop in femoral and calf arteries. In diabetes multifocal changes and calcification of arteries add to the impairment of tissue blood perfusion. In many patients reconstructive arterial surgery may improve blood flow. However, in multifocal obstructive changes surgery remains ineffective and external forces are needed to promote tissue blood perfusion.

Aim: To increase capillary blood perfusion in ischemic foot by means of limb pneumatic sleeve obstructing venous outflow and subsequently dilating blood capillaries in a retrograde fashion.

Material and methods: Twenty patients with leg ischemia due to multifocal arterial obstruction not suitable for reconstructive surgery were included. Claudication distance was <50m, 5 patients suffered from night pains, in 5 ischemic ulcers developed. ABI index<0.5. For treatment pneumatic arterial pumps inflating foot and calf chambers 5 sec each with a 20 sec deflation were used. Inflation pressure was 120mmHg. Daily usage of pumps for 1 h during one year period. Toes microcirculation was evaluated by point Doppler and plethysmography and calf arterial inflow by calf plethysmography. The same measurements were taken before and after one year therapy.

Results: Claudication distance increased by 50 to 150 m in each patient with individual differences. Toe capillary flow increased in all from 50mv to 150-300mv. No night pains. In 3 out of 5 ulcers filled up with granulation tissue. 

Conclusions: Pneumatic arterial flow support increased toe capillary flow in patients applying it daily for 1 year. Obstruction of venous outflow during pneumatic support brings about retrograde capillary dilatation. This in turn results in increased capillary flow. No significant increase in calf muscles arterial inflow was observed. Arterial support devices are recommended in patients with ischemic legs and ulcers not suitable for arterial reconstructive surgery.