Rapid foot and calf compression increases walking distance in patients with intermittent claudication: Results of a randomized study

Ramaswami, Ganesh; D’Ayala, Marcus; Hollier, Larry H.; Deutsch, Reena; McElhinney, A. James

doi:10.1016/j.jvs.2005.01.045

Cited by 46 publications

(39 citation statements)

References 23 publications

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“…However, here, we aimed to give fi rst evidence for long-term ISRT, and, indeed, we showed that walking distance improved with a more than two-fold increase in ICD and ACD in all of the tested PAD patients. Recent studies investigated the effect of diff erent compression devices on PAD patient outcome by focusing on peripheral perfusion and claudication pain [13,14]. Intermittent pneumatic calf and foot compression revealed a signifi cant improvement of the ICD and ACD after a daily treatment of 2 hours for 4 -6 months in a cohort of 30 patients [13].…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies investigated the effect of diff erent compression devices on PAD patient outcome by focusing on peripheral perfusion and claudication pain [13,14]. Intermittent pneumatic calf and foot compression revealed a signifi cant improvement of the ICD and ACD after a daily treatment of 2 hours for 4 -6 months in a cohort of 30 patients [13]. However, there was no initial examination that evaluated the patient's individual peripheral perfusion status under treatment.…”

Section: Discussionmentioning

confidence: 99%

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Adaptation of external counterpulsation based on individual shear rate therapy improves endothelial function and claudication distance in peripheral artery disease

Buschmann

Brix

et al. 2016

Vasa

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Peripheral artery disease (PAD) is the third leading cause of atherosclerotic cardiovascular morbidity and aff ects one in fi ve patients in primary care [1]. The overall number of PAD patients increased by 23.5 % over the last decade and has become a severe global health problem [2]. Nonsurgical and non-interventional treatment options for PAD patients comprise risk-factor modifi cation, pharmacological therapy and exercise. A supervised exercise program is a highly eff ective treatment option for PAD patients. However, intense training intervals elicit claudication and can be hindered by concomitant morbidities. Thus, novel therapies are needed.External counterpulsation is a non-invasive medical device, wherein pneumatic cuff s are wrapped around the lower limb and are triggered by an electrocardiogram. Upon diastole, the cuff s are infl ated, and at the onset of systole, they are defl ated again. During cuff infl ation, diastolic blood fl ow signifi cantly increases. This, in turn, leads to a profound increase in both intra-arterial shear rate and fl uid shear stress (FSS).Usually, external counterpulsation is applied with high pressures up to 250 or 300 mmHg, which is fre- Summary: Background: External counterpulsation therapy enhances blood fl ow and was shown to improve endothelial function and quality of life in coronary artery disease patients. However, high pressures of up to 300 mmHg may lead to malperfusion of the ischaemic limb. To improve the clinical outcome of patients with peripheral artery disease (PAD), we adjusted external counterpulsation and developed a novel non-invasive approach termed individual shear rate therapy (ISRT). Patients and methods: In the present study, 14 patients with a Fontaine stage IIb and femoral-popliteal PAD underwent 30 hours of ISRT over 5 weeks. For ISRT, individual treatment pressures that do not exceed 160 mmHg were assessed by Doppler fl ow parameters during counterpulsation (individual shear rate diagnosis) in order to enhance and maximise peripheral perfusion. The study aimed to enhance peripheral perfusion and evaluate the primary clinical endpoint endothelial function, as well as to perform preliminary analysis of the ankle brachial index (ABI) and walking distance. Results: Doppler fl ow measurements in the lower limb (ankle) validated that maximum blood fl ow velocity during systole and acceleration doubled during ISRT. Study results demonstrated that long-term ISRT signifi cantly increased fl ow-mediated dilation (FMD) in the brachial artery (0.13+/-0.09 mm to 0.38+/-0.05 mm; p < 0.05), while nitromediated dilation (0.36+/-0.10 mm to 0.45+/-0.08 mm) remained and common femoral artery FMD did not reach statistical signifi cance (0.38+/-0.08 mm to 0.67+/-0.19 mm; p<0.05). Initial claudication distance considerably improved for all patients after 30 hours of ISRT (92.6 +/-8.2 metres to 280+/-101.3 metres, p<0.05), just like the absolute claudication distance, which showed a more than 2.5-fold increase (167.8+/-18.1 metres to 446.7+/-133.3 metres; p<0.05). The...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Adaptation of external counterpulsation based on individual shear rate therapy improves endothelial function and claudication distance in peripheral artery disease

Buschmann

Brix

et al. 2016

Vasa

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“…The treadmill was calibrated before the test. The walking test was done according to international treadmill protocols 17,18) .…”

Section: Methodsmentioning

confidence: 99%

Therapeutic Effect of an Underwater Exercise Program for Patients with Peripheral Arterial Disease

et al. 2012

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Abstract. [Purpose] This study investigated the effect of a simple underwater training program on ambulatory functions of patients with peripheral vascular disease. [Subjects and Methods] Seven male patients participated in supervised underwater exercise training for twelve weeks to determine the effect of the program on their ambulatory capacity through comparison of their pre-and post-training values of their ambulatory indices, including toe pressure, maximum ambulatory distance, and ankle brachial index. [Results] We show that twelve weeks of underwater training improved the ambulatory functions and quality of life of patients with peripheral vascular disease.[Conclusion] This program should be considered as an effective conservative treatment for low risk patients with intermittent claudication.

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“…Because IPC is homebased, this treatment strategy overcomes the major limitations associated with the surgical and noninvasive therapeutic options available for these patients, including low accessibility and unsatisfactory cost-effectiveness (6,17). Clinical trials in stable claudicants indicate that 3 mo of daily IPC application can increase maximal walking distance by ϳ110% (5,9,27), an improvement that is comparable to that obtained by supervised exercise training (17,32). Despite the growing clinical acceptance, the fundamental mechanisms by which IPC therapy promotes clinical benefits remain unclear.…”

Section: Application Of Intermittent Pneumatic Leg Compressions (Ipc)mentioning

confidence: 99%

“…We also evaluated the time course and magnitude of IPC-induced changes in mRNA and protein expression of VEGF, MCP-1, and cytokine-induced neutrophil chemoattractant 1 (CXCL1/CINC-1) in the TA muscle. The second aim was to test the hypothesis that in limbs of chronic bilateral occluded rats, a higher compression frequency would evoke more robust changes in the expression of the aforementioned factors than 3 compressions/min, which is the frequency currently employed in commercially available devices (5,9,17,27). This hypothesis was based on previous results in healthy animals (28), where the higher frequency of compressions had greater effects on the expression of these genes.…”

Section: Application Of Intermittent Pneumatic Leg Compressions (Ipc)mentioning

confidence: 99%

Impact of a single session of intermittent pneumatic leg compressions on skeletal muscle and isolated artery gene expression in rats

Roseguini¹,

Arce‐Esquivel²,

Newcomer

et al. 2011

American Journal of Physiology-Regulatory, Integrative and Comp

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Roseguini BT, Arce-Esquivel AA, Newcomer SC, Laughlin MH. Impact of a single session of intermittent pneumatic leg compressions on skeletal muscle and isolated artery gene expression in rats. Am J Physiol Regul Integr Comp Physiol 301: R1658-R1668, 2011. First published September 28, 2011 doi:10.1152/ajpregu.00457.2011.-Intermittent pneumatic leg compressions (IPC) have proven to be an effective noninvasive approach for treatment of patients with claudication, but the mechanisms underlying the clinical benefits remain elusive. In the present study, a rodent model of claudication produced by bilateral ligation of the femoral artery was used to investigate the acute impact of a single session of IPC (150 min) on hemodynamics, skeletal muscle (tibialis anterior), and isolated collateral artery (perforating artery) expression of a subset of genes associated with inflammation and vascular remodeling. In addition, the effect of compression frequency (15 vs. 3 compressions/min) on the expression of these factors was studied. In ligated animals, IPC evoked an increase of monocyte chemoattractant protein-1 (MCP-1) and cytokine-induced neutrophil chemoattractant 1 (CXCL1) mRNA (P Ͻ 0.01) and immunostaining (P Ͻ 0.05), as well as a minor increase in VEGF immunostaining in the muscle endomysium 150 min postintervention. Further, collateral arteries from these animals showed an increased expression of MCP-1 (approximately twofold, P ϭ 0.02). These effects were most evident in the group exposed to the high-frequency protocol (15 compressions/min). In contrast, IPC in sham-operated control animals evoked a modest initial upregulation of VEGF (P ϭ 0.01), MCP-1 (P ϭ 0.02), and CXCL1 (P ϭ 0.03) mRNA in the muscle without concomitant changes in protein levels. No changes in gene expression were observed in arteries isolated from sham animals. In conclusion, IPC acutely up-regulates the expression of important factors involved in vascular remodeling in the compressed muscle and collateral arteries in a model of hindlimb ischemia. These effects appear to be dependent on the compression frequency, such that a high compression frequency (15 compressions/min) evokes more consistent and robust effects compared with the frequency commonly employed clinically to treat patients with claudication (3 compressions/min).

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Rapid foot and calf compression increases walking distance in patients with intermittent claudication: Results of a randomized study

Cited by 46 publications

References 23 publications

Adaptation of external counterpulsation based on individual shear rate therapy improves endothelial function and claudication distance in peripheral artery disease

Adaptation of external counterpulsation based on individual shear rate therapy improves endothelial function and claudication distance in peripheral artery disease

Therapeutic Effect of an Underwater Exercise Program for Patients with Peripheral Arterial Disease

Impact of a single session of intermittent pneumatic leg compressions on skeletal muscle and isolated artery gene expression in rats

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