Prospective Randomized Controlled Trial to Analyze the Effects of Intermittent Pneumatic Compression on Edema Following Autologous Femoropopliteal Bypass Surgery

Abstract

BackgroundPatients who undergo autologous femoropopliteal bypass surgery develop postoperative edema in the revascularized leg. The effects of intermittent pneumatic compression (IPC) to treat and to prevent postreconstructive edema were examined in this study.MethodsIn a prospective randomized trial, patients were assigned to one of two groups. All patients suffered from peripheral arterial disease, and all were subjected to autologous femoropopliteal bypass reconstruction. Patients in group 1 used a compression stocking (CS) above the knee exerting 18 mmHg (class I) on the leg postoperatively for 1 week (day and night). Patients in group 2 used IPC on the foot postoperatively at night for 1 week. The lower leg circumference was measured preoperatively and at five postoperative time points. A multivariate analysis was done using a mixed model analysis of variance.ResultsA total of 57 patients were analyzed (CS 28; IPC 29). Indications for operation were severe claudication (CS 13; IPC 13), rest pain (10/5), or tissue loss (7/11). Revascularization was performed with either a supragenicular (CS 13; IPC10) or an infragenicular (CS 15; IPC 19) autologous bypass. Leg circumference increased on day 1 (CS/IPC): 0.4%/2.7%, day 4 (2.1%/6.1%), day 7 (2.5%/7.9%), day 14 (4.7%/7.3%), and day 90 (1.0%/3.3%) from baseline (preoperative situation). On days 1, 4, and 7 there was a significant difference in leg circumference between the two treatment groups.ConclusionsEdema following femoropopliteal bypass surgery occurs in all patients. For the prevention and treatment of that edema the use of a class I CS proved superior to treatment with IPC. The use of CS remains the recommended practice following femoropopliteal bypass surgery.

Three-year outcome of the heparin-bonded Viabahn for superficial femoral artery occlusive disease

“…The incidence of these complications varies between 5% and 60%. [22][23][24][25] Our study showed an overall complication rate of 16%. Because of its minimally invasive character and a low complication and amputation rate, treatment with a heparin-bonded endograft could also be considered a supplementary treatment option, thus postponing surgical reconstructions.…”

Results of heparin-bonded ePTFE-covered stents for chronic occlusive superficial femoral artery disease

“…[17][18][19][20] The minimally invasive character of an endovascular reconstruction may well decrease morbidity in these often frail patients. The overall complication rate in our study was only 7.5%, which then again may seem high for an endovascular procedure, emphasizing the vulnerability of this patient group.…”

Quality of Life in Perspective to Treatment of Postoperative Edema After Peripheral Bypass Surgery

“…Further information on the trial design, the effects on the formation of postoperative edema, and changes in inflammatory parameters are reported elsewhere. 17,18 Approval was granted by both a nationally recognized medical ethical review committee and the hospital's medical ethical review committee. All patients who participated in this study gave written informed consent.…”

“…Patients in both surgery groups were allocated to either the CS group or the IPC group according to the randomization strategies. 17,18 The patients in the CS group used an above-the-knee class I stocking (BREVET tx; M€ olnlycke, G€ oteborg, Sweden), exerting up to 18 mm Hg pressure to the leg continuously during 1 week following surgery. IPC group patients received the A-V impulse technology (Orthofix Vascular Novamedix, Andover, UK) during 1 week at night, starting the night following the operation.…”

“…15,16 However, failure of IPC to decrease edema formation following autologous and polytetrafluoroethylene (PTFE) femoropopliteal bypass surgery was reported recently. 17,18 As part of this study, the effects of femoropopliteal bypass surgery on patients' QoL were prospectively assessed with the WHOQOL-BREF instrument, 1 day before surgery and 2 weeks and 3 months after surgery.…”