Real-time Pressures in Lower Extremity Compression Therapy

Introduction: Compression therapy has become a mainstay in the treatment of lymphedema, venous insufficiency, deep vein thrombosis, and post thrombotic syndrome for the lower extremities. External pressure applied to the lower extremity channels blood from superficial to deep veins thus promoting venous return. To accomplish this therapeutic effect, adequate compression must be applied in a graduated fashion. We sought to measure real world compression pressure achieved with manually adjustable compression devices.     

Methods: All testing took occurred in a tertiary wound care center. Pressure measurements were recorded using the PicoPress® Compression Measurement System (MediGroup, Australia) on the same individual. Readings were recorded at the ankle and calf. Compression device manufacturers were selected from those that are commonly prescribed by the center’s physicians. Each device was sized to the individual according to manufacturer recommendation.  

Results: Two of the three tested devices met or exceeded assumed pressures in the 20-30 and 30-40mmHg ranges. All devices had higher pressures distally (ankle) than proximal (calf). All devices were capable of adjustable pressures. As desired pressure increased, the ability of all three devices to increase pressure at the calf diminished, however. All three devices were unable to achieve a pressure over 40mmHg at the calf when adjusted to into the 40-50mmHg range. 

Discussion: The greatest obstacle to accurate compression was understanding the proper method of application for the device. This highlights the need for greater patient education and instruction in the use of adjustable compression devices. The maintenance and continued efficacy of said devices should also be monitored by providers as part of a routine follow up.