Labropoulos Nicos, Leon Luis R, Bhatti Ahmad, Melton Steven, Kang Steven S, Mansour Ashraf M, Borge Marc
Department of Surgery, Loyola University Medical Center, Maywood, Ill, USA.
J Vasc Surg. 2005 Oct;42(4):710-6. doi: 10.1016/j.jvs.2005.05.051.
Traditional teaching assumes that the distal arterial tree is maximally dilated in patients with critical limb ischemia (CLI). Endovascular or arterial bypass procedures are the commonly used interventions to increase distal perfusion. However, other forms of treatment such as spinal cord stimulation or intermittent pneumatic compression (IPC) have been shown to improve limb salvage rates. This prospective study was designed to determine if the use of IPC increases popliteal, gastrocnemial, collateral arterial, and skin blood flow in patients with CLI.
Twenty limbs with CLI in 20 patients (mean age, 74 years) were evaluated with duplex ultrasound scans and laser Doppler fluxmetry in the semi-erect position before, during, and after IPC. One pneumatic cuff was applied on the foot and the other on the calf. The maximum inflation pressure was 120 mm Hg and was applied for 3 seconds at three cycles per minute. All patients had at least two-level disease by arteriography. Fourteen limbs were characterized as inoperable, and six were considered marginal for reconstruction. Flow volumes were measured in the popliteal, medial gastrocnemial, and a genicular collateral artery. Skin blood flux was measured on the dorsum of the foot at the same time.
Significant flow increase during the application of IPC was found in all three arteries (18/20 limbs) compared with baseline values (P < .02). The highest change was seen in the popliteal, followed by the gastrocnemial and the collateral artery. After the cessation of IPC, the flow returned to baseline. This was attributed to the elevation of time average velocity, as the diameter of the arteries remained unchanged. The skin blood flux increased significantly as well (P < .03). In the two limbs without an increase in the arterial or skin blood flow, significant popliteal vein reflux was found. Both limbs were amputated shortly after.
IPC increases axial, muscular, collateral, and skin blood flow in patients with CLI and may be beneficial to those who are not candidates for revascularization. Patients with significant venous reflux may not benefit from IPC. This supports the theory that one of the mechanisms by which IPC enhances flow is by increasing the arteriovenous pressure gradient.
传统教学认为，在严重肢体缺血（CLI）患者中，远端动脉树处于最大程度的扩张状态。血管内介入治疗或动脉搭桥手术是常用的增加远端灌注的干预措施。然而，其他形式的治疗，如脊髓刺激或间歇性气动压迫（IPC），已被证明可提高肢体挽救率。这项前瞻性研究旨在确定IPC的使用是否能增加CLI患者的腘动脉、腓肠肌动脉、侧支动脉和皮肤血流量。
对20例患者（平均年龄74岁）的20条CLI肢体在IPC治疗前、治疗期间和治疗后采用双功超声扫描和激光多普勒血流仪进行半直立位评估。一个气动袖带套在足部，另一个套在小腿部。最大充气压力为120 mmHg，以每分钟3个周期的频率施加3秒。所有患者经血管造影显示至少有两级病变。14条肢体被判定为无法进行手术，6条肢体被认为勉强适合重建。测量腘动脉、腓肠肌内侧动脉和一条膝侧支动脉的血流量。同时测量足部背侧的皮肤血流。
与基线值相比，在所有三条动脉（18/20条肢体）中，IPC应用期间血流量显著增加（P < .02）。腘动脉的变化最大，其次是腓肠肌动脉和侧支动脉。IPC停止后，血流量恢复到基线水平。这归因于时间平均速度的升高，因为动脉直径保持不变。皮肤血流量也显著增加（P < .03）。在两条动脉或皮肤血流量未增加的肢体中，发现明显的腘静脉反流。这两条肢体在不久后均被截肢。
IPC可增加CLI患者的轴向、肌肉、侧支和皮肤血流量，可能对那些不适合进行血管重建的患者有益。有明显静脉反流的患者可能无法从IPC中获益。这支持了IPC增强血流的机制之一是增加动静脉压力梯度的理论。
