The efficacy and safety of enhanced external counterpulsation in patients with peripheral arterial disease

Abstract

Peripheral arterial disease (PAD) is common in patients with severe coronary artery disease (CAD) and is considered a relative contraindication to external enhanced counterpulsation (EECP), but there are no data that define the efficacy and safety of EECP in patients with PAD. The International EECP Patient Registry (IEPR) was used to compare initial posttherapy and 2-year follow-up clinical outcomes and adverse event rates in patients with and without PAD. From January 2002 to October 2004, 2126 patients were enrolled in the IEPR, of whom 493 (23%) had a history of PAD. Immediately following EECP, the reduction in angina (≥ 1 Canadian Cardiovascular Society class) was similar in patients with and without PAD (76.6% vs 79.0%, p = 0.27) as was improvement in the Duke Activity Score Index (DASI) score (+4.7% vs +6.1%, p < 0.001). Both angina reduction and DASI score improvement were sustained at 2 years. PAD patients discontinued EECP more frequently (12.0% vs 8.5%, p < 0.05), but lower extremity ulceration did not occur more frequently in patients with PAD (3.7% vs 2.7%, p = 0.26). Rates of death (17.1% vs 8.6%, p < 0.001) and myocardial infarction (9.5% vs 5.0%, p < 0.001) were, as expected, higher in patients with PAD compared to patients without PAD at 2 years. In conclusion, while PAD patients constitute a high-risk cohort with known higher adverse event rates, EECP led to similar short-and longterm improvements in angina and quality of life for individuals with PAD compared to those without PAD.

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

“…If, as discussed above, increased circumferential stretch in collateral arteries and repeated forceful compressions of the muscles are also important, it would be appropriate to select a frequency that enhances the action of these mechanisms. Along these lines, alternative compression strategies that employ much higher frequencies, such as enhanced external counterpulsation, have begun to be tested in cohorts of patients with claudication (1,35). These initial studies indicate that the extremely high frequencies adopted in these devices are safe and seem to be associated with improved outcomes in these patients (35).…”

“…Along these lines, alternative compression strategies that employ much higher frequencies, such as enhanced external counterpulsation, have begun to be tested in cohorts of patients with claudication (1,35). These initial studies indicate that the extremely high frequencies adopted in these devices are safe and seem to be associated with improved outcomes in these patients (35). Therefore, it is conceivable that long-term IPC at a higher frequency than currently employed could magnify the established positive clinical results.…”

Possibilities of Enhanced External Counterpulsation Using in Clinical Practice

“…Перспективным является применение УНКП при реабилитации пациентов после ишемического ин-сульта [54], сосудистых заболеваний сетчатки [55], пациентов с заболеваниями периферических арте-рий [56] с целью улучшения эректильной функции [57] и других состояниях (рис. 4) [58].…”

“…Доказательная база уже включает тысячи пациентов с данными заболева-ниями, успешно прошедших лечение при помощи УНКП. При этом переносимость лечения и его без-опасность отличаются довольно благоприятным про-филем [40,56]. Конечно же, УНКП не является панацеей, а должна быть компонентом комплексного подхода при лечении пациентов.…”

Panta rhei: Everything flows - flow is everything Comment on Buschmann et al, p. 317 - 324

“…This is usually achieved by ECG triggered rhythmic infl ation of pneumatic cuff s around the lower extremities at high pressures (up to 300mmHg). Although recent studies provide evidence that this so-called enhanced external counterpulsation (EECP) therapy may be safe in peripheral artery disease (PAD) patients [6], it is normally contra-indicated due to the risk of decreasing arterial blood fl ow to the limb, potentially jeopardising the ischaemic tissue [5]. Hence, we need to take a step back and concentrate on the physiological mechanisms behind (E)ECP before the unfounded application of standard protocols.…”