Center for Venous and Peripheral Arterial Diseases, Eifelklinik St Brigida, Simmerath, Germany.
European Venous Centre Aachen-Maastricht, University Hospital Aachen, Aachen, Germany.
J Vasc Surg Venous Lymphat Disord. 2021 Nov;9(6):1526-1534.e2. doi: 10.1016/j.jvsv.2021.02.011. Epub 2021 Mar 2.
Intermittent pneumatic compression (IPC) is an established treatment option to remove tissue fluid from patients with lymphedema and chronic venous disease. The effects of IPC applied directly after varicose vein surgery performed with high volumes of tumescent local anesthesia have not been investigated. The aim of the present study was to evaluate the use of postoperative IPC concerning its effects on the leg volume and patient comfort after surgery.
We performed an investigator-initiated, single-center, open-label randomized controlled trial. A total of 186 patients indicated for saphenofemoral junction ligation and great saphenous vein or anterior accessory saphenous vein stripping or great saphenous vein redo surgery were randomly assigned 1:1 to the intervention or control group. The patients in the intervention group were treated with IPC at 40 mm Hg for 45 minutes directly after surgery. The outcome measures were the leg volume changes calculated using an optical three-dimensional scanning system (primary objective), quality of life (QoL; Freiburg Life Quality Assessment for chronic venous disease, short form), pain, and extent of ecchymosis with follow-up examinations on days 1 and 7 after surgery.
The patients in both groups had comparable mean leg volume reductions from baseline to day 1 (IPC group, 58.8 mL; control group, 37.4 mL; P = .967) and to day 7 (63.1 mL and 57.0 mL, respectively; P = .546). We also did not observe significant differences between the two groups in QoL and pain. The patients in the IPC group had developed larger areas of ecchymosis compared with the control group (16% vs 13.3% of leg surface, respectively; P = .046), with a tendency toward an increase in pain at 7 days after surgery compared with no IPC application.
The present randomized controlled trial was designed to evaluate the decongestive effects of a single postoperative session of IPC and its effect on QoL, pain, and ecchymosis in patients who had undergone varicose vein surgery under tumescent local anesthesia. Because no evidence for a benefit from IPC could be found in the present study and increased ecchymosis was found, its standard use after varicose vein surgery cannot be recommended.
间歇性气动压迫（IPC）是一种已确立的治疗选择，可从患有淋巴水肿和慢性静脉疾病的患者中去除组织液。尚未研究在使用大量肿胀局部麻醉进行静脉曲张手术后直接应用 IPC 的效果。本研究的目的是评估手术后使用 IPC 对腿部体积和手术后患者舒适度的影响。
我们进行了一项由研究者发起的、单中心、开放标签的随机对照试验。共有 186 名患者被指示接受隐股交界处结扎和大隐静脉或前辅助隐静脉剥离或大隐静脉再手术，随机分为干预组和对照组，每组 1：1。干预组患者在手术后直接接受 40mmHg 的 IPC 治疗 45 分钟。主要结局是使用光学三维扫描系统（主要目的）计算的腿部体积变化、生活质量（弗赖堡慢性静脉疾病生活质量评估，短格式）、疼痛和瘀斑程度，在手术后第 1 天和第 7 天进行随访检查。
两组患者从基线到第 1 天（IPC 组，58.8ml；对照组，37.4ml；P=0.967）和第 7 天（63.1ml 和 57.0ml，分别；P=0.546）的腿部体积平均减少量相似。我们还没有观察到两组之间在生活质量和疼痛方面有显著差异。与对照组相比，IPC 组的患者出现了更大面积的瘀斑（分别为腿部表面积的 16%和 13.3%；P=0.046），并且与不使用 IPC 相比，术后第 7 天疼痛增加。
本随机对照试验旨在评估单次术后 IPC 对接受肿胀局部麻醉下静脉曲张手术后患者的消肿效果及其对生活质量、疼痛和瘀斑的影响。由于本研究未发现 IPC 的益处证据，并且发现瘀斑增加，因此不能推荐其在静脉曲张手术后的常规使用。
