Observational retrospective study on the effectiveness of sequential graduated intermittent pneumatic compression therapy of lower limbs edema

Abstract

The main aim of the study is to evaluate the effectiveness of sequential graduated intermittent pneumatic compression (SGIPC)
therapy of lower limbs edema, regardless of its etiology. A retrospective observational study is conducted to determine the effectiveness
of a regimen of sequential gradient SGIPC in treating edema of lower limbs. The study is carried out on 90 patients affected by
different stages of edema and evaluated at a Wound Care Clinic for one month. Medical records data have been collected after the
first, the third, and the fifth hour-long treatment session. The inclusion criteria are: (1) presence of edema to one limb, at least,
regardless of etiology, (2) presence of both pain and feeling of heaviness (or tiredness) of the limb, (3) non-use of bandages or elastic
stocking/knee socks, and (4) availability of complete data about the edema size monitoring. The exclusion criteria are: (1) presence
of infected wounds, (2) severe arteriosclerosis or other ischemic vascular diseases, (3) severe congestive cardiac failure, (4) known or
suspected acute deep vein thrombosis (DVT), (5) thrombophlebitis or Pulmonary Embolism (PE), and (6) hypertension (Systolic
Pressure greater than 170mmHg). The following parameters are considered as grade of improvement: the decrease of the limb
circumference in at least two measurement points between the foot, ankle, and calf; the disappearance of at least one of the
symptoms of pain and feeling of heaviness of the limb; improved mobility. A Flowtron ACS 900 system is used, for the treatment,
consisting of a pump, connected to two (calf and thigh) brace with individual tubes, applying a pneumatic compression, graduated
in the air chamber, with sequential cycle in three compartments (one at the calf level and two at the thigh level), at a pressure of
45mmHg, with inflation cycles intermittent alternating. Inflation time 12s, time of deflation 48s. In addition, braces
corresponding to limb size have been used (automatically recognized by the system).
In a sample of 90 patients (95.6% women and 4.4% men) with edema of the lower limbs (37.8% at stage 1, 43.3% at stage 2,
15.6% at stage 3, and 3.3% at stage 4), a successful treatment has been found, from the first session. A circumference decrease
greater than 3mm in at least two measuring points between the foot, ankle, and calf, of 77.8% after the first session, 90% after the
third session, 90% after the fifth session, on average for both limbs. The disappearance of pain at the end of the session has been
found in 85.6% of cases after the first session and 100% after the third and fifth, respectively. The feeling of heaviness of the limb
has disappeared in 100% of cases at the end of the sessions. For the stages 3 and 4, it is generally observed an improvement of
mobility in 58.9% of cases at the end of the first session and equal to 100% after the third and fifth session. A good compliance in
patients who have rejected the manual lymph drainage has been found. Moreover, a good applicability has been found in patients
with critical issues such as dermatoporosis and capillary fragility, and bariatric patients. In general, the patients have
underestimated the edema, specifically only 21% of patients at a stage greater or equal to 2 have recognized the edema as a clinical
problem.