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Nickles MA, Ennis WJ, O'Donnell TF, Altman IA. Compression therapy in peripheral artery disease: a literature review. J Wound Care 2023; 32:S25-S30. [PMID: 37121666 DOI: 10.12968/jowc.2023.32.sup5.s25] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
OBJECTIVE Our objective is to examine the pathophysiology of oedema in the ischaemic and post-revascularised limb, compare compression stockings to pneumatic compression devices, and summarise compression regimens in patients with severe peripheral artery disease (PAD) without revascularisation, after revascularisation, and in mixed arterial and venous disease. METHOD A scoping literature review of the aforementioned topics was carried out using PubMed. RESULTS Compression therapy has been shown to increase blood flow and aid in wound healing through a variety of mechanisms. Several studies suggest that intermittent pneumatic compression (IPC) devices can be used to treat critical limb ischaemia in patients without surgical options. Additionally, compression stockings may have a role in preventing oedema after peripheral artery bypass surgery, thereby diminishing pain and reducing the risk of surgical wound dehiscence. CONCLUSION Oedema may occur in the ischaemic limb after revascularisation surgery, as well as in combination with venous disease. Clinicians should not fear using compression therapy in PAD.
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Affiliation(s)
| | - William J Ennis
- Department of Surgery, University of Illinois at Chicago, Chicago, IL, US
| | | | - Igor A Altman
- Department of Surgery, University of Illinois at Chicago, Chicago, IL, US
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Lamberti N, Manfredini F, Tessari M, Menegatti E, Nardi F, Basaglia N, Zamboni P. A near-infrared spectroscopy-assisted test discriminates patients with peripheral arterial disease and venous insufficiency with changes of foot oxygenation following light elastic compression therapy. VASA 2019; 48:361-367. [PMID: 30838936 DOI: 10.1024/0301-1526/a000780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background: Elastic compression therapy (CT) in patients with peripheral artery disease (PAD) and chronic venous insufficiency (CVI) may compromise arterial perfusion. We evaluated the feasibility of a toe-flexion test, which quantifies dynamic foot perfusion by near-infrared spectroscopy (NIRS), for the assessment of hemodynamic sustainability of CT in PAD patients with CVI. Patients and methods: In this prospective observational study, PAD patients aged 50-85 with combined CVI at CEAP stages II-IV were studied. The ankle-brachial index (ABI) was measured, and foot perfusion was determined after 10 consecutive toe-flexion movements with NIRS sensors placed on the dorsum of each foot. Knee-high open-toe compression stockings were applied, and the degree of compression was measured. Toflex-area was determined by calculating the area under the curve of the oxygenated hemoglobin track recorded by NIRS. A toflex-area reduction > 20 % following CT was arbitrarily defined to identify limbs of patients with improved foot perfusion. These subjects received CT to be worn and a diary to report adherence and symptoms. Results: Forty-seven PAD patients (74 ± 9 years; ABI 0.67 ± 0.24) with CVI were enrolled. For all legs, superimposable toflex-areas were observed for the first two attempts (ICC 0.92). Following application of CT (17 ± 2 mmHg), the toflex-area improved (from -162 ± 110 a.u. to -112 ± 104 a.u.; p < .001). Sixty-two limbs (n = 32 patients) exhibited improved foot perfusion after CT, with a mean variation of 80 ± 47 a.u., while 32 limbs (n = 23 patients) showed stable or worsened values. In a regression model, favorable variations in toflex-area after CT were linked to a worse baseline toflex-area (R2 = 0.18; p < 0.001; rpartial = -0.42) while the percentage improvement directly correlated with CEAP class (p = 0.033). Conclusions: The NIRS-assisted test, which is feasible in a laboratory context, objectively discriminates the hemodynamic tolerability of the treatment and identifies subjects with combined PAD and CVI with improved perfusion after CT, in spite of the presence of PAD.
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Affiliation(s)
- Nicola Lamberti
- 1 Department of Biomedical and Surgical Specialties Sciences, University of Ferrara, Ferrara, Italy
| | - Fabio Manfredini
- 1 Department of Biomedical and Surgical Specialties Sciences, University of Ferrara, Ferrara, Italy.,2 Unit of Physical and Rehabilitation Medicine, University Hospital of Ferrara, Ferrara, Italy
| | - Mirko Tessari
- 3 Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Erica Menegatti
- 3 Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy.,4 Unit of Translational Surgery, University Hospital of Ferrara, Ferrara, Italy
| | - Francesca Nardi
- 1 Department of Biomedical and Surgical Specialties Sciences, University of Ferrara, Ferrara, Italy
| | - Nino Basaglia
- 2 Unit of Physical and Rehabilitation Medicine, University Hospital of Ferrara, Ferrara, Italy
| | - Paolo Zamboni
- 3 Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy.,4 Unit of Translational Surgery, University Hospital of Ferrara, Ferrara, Italy
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Klocker J, Chemelli A, Bodner G, Gschwendtner A, Perkmann R, Tauscher T, Jaschke W, Fraedrich G. Hyperperfusion Syndrome of the Deltoid Muscle after Subclavian Artery Angioplasty and Stenting. J Endovasc Ther 2016; 10:833-7. [PMID: 14533956 DOI: 10.1177/152660280301000422] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To report a case of hyperperfusion syndrome of the deltoid muscle after percutaneous transluminal angioplasty of a symptomatic high-grade subclavian artery stenosis. Case Report: Immediately after balloon dilation of a left-sided subclavian artery stenosis, a 53-year-old man developed severe ipsilateral shoulder pain and swelling. Computed tomographic angiography revealed no extravasation or hematoma. Sonography showed massive edema and increased anteroposterior diameter of the left deltoid muscle (3.5 cm compared to 2.0 cm on the right). Hyperperfusion syndrome was suspected, and decompression by anterolateral fasciotomy was performed. Subsequently, both pain and swelling decreased. At day 3, the skin incision, which was temporarily covered with a synthetic skin substitute, was sutured; the wound healed uneventfully. Two weeks after surgery, both muscle strength and shoulder movements showed no restrictions. Conclusions: Hyperperfusion syndrome after endovascular treatment of subclavian artery stenosis should be considered in the differential diagnosis of atypical muscle pain in the upper extremity. It may present as a compartment syndrome requiring surgical decompression.
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Affiliation(s)
- Josef Klocker
- Department of Vascular Surgery, University of Innsbruck, Austria.
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Al-Daakak ZM, Ammouri AA, Isac C, Gharaibeh H, Al-Zaru I. Symptom management strategies of Jordanian patients following coronary artery bypass grafting surgery. Int J Nurs Pract 2016; 22:375-83. [PMID: 27241589 DOI: 10.1111/ijn.12445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 02/15/2016] [Accepted: 03/22/2016] [Indexed: 11/30/2022]
Abstract
The aim of this study was to explore the symptom management strategies utilized by post coronary artery bypass graft (CABG) patients and its associations with demographic variables. A clear understanding of the use of symptom management strategies following CABG surgery may help nurses in developing educational program and interventions that help patients and their families during recovery period after discharge. A cross-sectional, descriptive design was utilized. A convenience sample of 100 Jordanian patients post CABG surgery selected from five hospitals was surveyed between November 2012 and June 2013 using the Cardiac Symptom Survey. Chi squared analyses were used to examine the associations between the symptoms management strategies and selected demographic variables. Frequency of symptom management strategies utilized by post CABG patients revealed that most frequently employed strategies were use of medications (79%), repositioning (54%) and the rest (45%). Symptom management strategies utilized for poor appetite, sleeping problem and fatigue had significant associations with demographic variables. By providing information about the symptoms expected after surgery and possible ways to manage them, will strengthen the patients psychologically and will make CABG experience within the realm of self-management and coping.
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Affiliation(s)
- Zaher Mohammed Al-Daakak
- Department of Emergency and public Safety, Ministry of Interior General Head Quarters, Abu Dhabi, United Arab Emirates
| | | | - Chandrani Isac
- College of Nursing, Sultan Qaboos University, Muscate, Oman
| | - Huda Gharaibeh
- College of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Ibtisam Al-Zaru
- College of Nursing, Jordan University of Science and Technology, Irbid, Jordan
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5
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te Slaa A, Dolmans DEJGJ, Ho GH, Moll FL, van der Laan L. Pathophysiology and treatment of edema following femoropopliteal bypass surgery. Vascular 2012; 20:350-9. [PMID: 22983547 DOI: 10.1258/vasc.2011.ra0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Substantial lower-limb edema affects the majority of patients who undergo peripheral bypass surgery. Edema has impairing effects on the microvascular and the macrovascular circulation, causes discomfort and might delay the rehabilitation process of the patient. However, the pathophysiology of this edema is not well understood. The Cochrane Library and Medline were used to retrieve literature on edema following peripheral bypass surgery. Factors other than local wound healing alone are suggested in the literature to play a role, given the severity and duration of this edema. Hyperemia, microvascular permeability, reperfusion-associated inflammation and lymphatic disruptions are likely to facilitate the development of edema. Preventive methods could be lymphatic-sparing surgery, intraoperative antioxidative therapy and postoperative elevation. Successful treatment strategies to reduce postoperative edema are based on lymph massage and external compression. In conclusion, the pathophysiology of edema following peripheral surgery is not fully understood, although reperfusion-associated inflammation and lymphatic disruptions are likely to play a crucial role. When future less-invasive techniques prove to be successful, postoperative edema might be minimized. Until then, a careful lymphatic-sparing dissection should be executed when performing a peripheral bypass reconstruction. Postoperatively, the use of compression stockings and leg elevation are currently the golden standards.
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Affiliation(s)
- A te Slaa
- Department of Surgery, Amphia Hospital, Breda, The Netherlands.
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Haghshenasskashani A, Varcoe RL. A new negative pressure dressing (PrevenaTM) to prevent wound complications following lower limb distal arterial bypass. ACTA ACUST UNITED AC 2011. [DOI: 10.1177/1474651410397244] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Wound complications in patients undergoing distal arterial bypass grafting are common and can lead to loss of limb and life. Vacuum-assisted closure (VAC) has been in use for some time and has proven to expedite the process of wound healing when used in those with open sterile or infected wounds. Recent modifications to the VAC system to make it a topical closed incision dressing have been successful and led to the development of the new PrevenaTM dressing. We present the first application of this purpose-built closed incision site vacuum dressing in a patient with multiple potential risk factors undergoing popliteal-tibial bypass grafting.
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Affiliation(s)
| | - Ramon L Varcoe
- University of New South Wales, Sydney, NSW, Australia, Prince of Wales Hospital, Sydney, NSW, Australia,
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7
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Open versus endovascular repair of popliteal artery aneurysms. J Vasc Surg 2010; 51:271-6. [PMID: 20117505 DOI: 10.1016/j.jvs.2009.09.060] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Revised: 09/14/2009] [Accepted: 09/15/2009] [Indexed: 11/24/2022]
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Tsui JCS, Baker DM, Shaw SG, Shi-Wen X, Dashwood MR. Nitric oxide synthase in critically ischaemic muscle and alterations in isoform expression during revascularization surgery. Br J Surg 2007; 95:72-9. [PMID: 17849374 DOI: 10.1002/bjs.5910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Dysfunction of the nitric oxide pathway is implicated in peripheral arterial disease. Nitric oxide synthase (NOS) isoforms and NOS activity were studied in muscle from patients with critical leg ischaemia (CLI). Alterations in NOS during revascularization surgery were also assessed. METHODS Muscle biopsies were taken from patients with CLI undergoing amputation and also from patients undergoing femorodistal bypass at the start of surgery, after arterial clamping and following reperfusion. The presence of NOS within muscle sections was confirmed using reduced nicotinamide adenine dinucleotide phosphate diaphorase histochemistry. NOS isoform distribution was studied by immunohistochemistry. NOS mRNA and protein levels were measured using real-time reverse transcriptase-polymerase chain reaction and western blotting. NOS activity was assessed with the citrulline assay. RESULTS All three NOS isoforms were found in muscle, associated with muscle fibres and microvessels. NOS I and III protein expression was increased in CLI (P = 0.041). During revascularization, further ischaemia and reperfusion led to a rise in NOS III protein levels (P = 0.008). NOS activity was unchanged. CONCLUSION Alterations in NOS I and III occurred in muscle from patients with CLI and further changes occurred during bypass surgery.
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Affiliation(s)
- J C S Tsui
- Department of Surgery, Royal Free and University College Medical School, London, UK.
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Frässdorf J, Luther B, Müllenheim J, Otto F, Preckel B, Schlack W, Thämer V. Influence of groin incision, duration of ischemia, and prostaglandin E1 on ischemia-reperfusion injury of the lower limb. J Cardiothorac Vasc Anesth 2006; 20:187-95. [PMID: 16616658 DOI: 10.1053/j.jvca.2005.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2004] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The influences of groin incision, duration of ischemia, and the effects of prostaglandin E1 (PGE1) on ischemia-reperfusion (I/R) injury of the hind limb in rabbits were evaluated. DESIGN A prospective study. SETTING Laboratory. PARTICIPANTS In 64 rabbits, bilateral hind limb ischemia was induced by occlusion of the abdominal aorta. Volume changes, neuromuscular function of the hind limb, and creatine kinase (CK) release were measured as variables of tissue injury. INTERVENTIONS Eight rabbits served as untreated controls (CON). In 2 groups (each n = 14), 3 hours of ischemia were followed by 3 hours of reperfusion (I/R). In 2 different groups (each n = 14), 45 minutes of ischemia were followed by 2 hours of reperfusion. To determine effects of PGE1, 1 I/R group of each ischemia duration was treated intravenously with 80 ng/kg/min of PGE1 starting 30 minutes after the onset of ischemia (I/R-PGE1). To determine effects of groin incision on edema formation, volume changes were determined in the "operated" right (CON-R, 3h-R, 3h-PGE1-R and 45 min-R, 45 min-PGE1-R) or in the "nonoperated" left hind limb (CON-L, 3h-L, 3h-PGE1-L and 45 min-L, 45 min-PGE1-L), representing a subgroup analysis. MEASUREMENTS AND MAIN RESULTS Volume changes after I/R occurred only in operated legs after ischemia (3h-R: 2.3 +/- 0.3 mL, p < 0.0001 v CON-R and 3h-L; 45 min-R: 0.8 +/- 0.2 mL, p < 0.01 v 45 min-L). PGE1 reduced edema formation in the operated legs (3h-PGE1-R: 1.0 +/- 0.4 mL, p < 0.0001 v 3h-R; 45 min-PGE1-R: 0.5 +/- 0.3 mL, p = 1.0 v 45 min-R). Groin incision without I/R had no effect on edema formation (CON-R: -0.13 +/- 0.17 mL of baseline). The increase of CK release from 616 +/- 584 U/L in controls to 5,921 +/- 2,156 U/L after 3 hours of ischemia (p < 0.001) was attenuated by treatment with PGE1 (3,732 +/- 2,653, p < 0.05 v I/R). Forty-five minutes of ischemia did not lead to cellular damage as measured by CK release (I/R: 606 +/- 364 U/L). Recovery of neuromuscular function was not affected by PGE1. CONCLUSION Development of edema during I/R depends on groin incision of the hind limb and on the duration of ischemia. The I/R injury is attenuated by PGE1 treatment, in terms of reduced edema formation and CK release, but not in terms of neuromuscular function.
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Affiliation(s)
- Jan Frässdorf
- Department of Anesthesiology, University Hospital of Düsseldorf, Düsseldorf, Germany.
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Klocker J, Chemelli A, Bodner G, Gschwendtner A, Perkmann R, Tauscher T, Jaschke W, Fraedrich G. Hyperperfusion Syndrome of the Deltoid Muscle After Subclavian Artery Angioplasty and Stenting. J Endovasc Ther 2003. [DOI: 10.1583/1545-1550(2003)010<0833:hsotdm>2.0.co;2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Vowden P. Timing of Doppler ankle brachial pressure index. J Wound Care 2001; 10:266. [PMID: 12964345 DOI: 10.12968/jowc.2001.10.7.26253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Are there any guidelines or research evidence to support when it is appropriate to perform a Doppler ankle brachial pressure index (ABPI) after a client has had arterial bypass surgery on their leg? Some vascular surgeons say never, some say six months. As these clients often have reperfusion oedema, it is useful to know ABPI to assist the choice of compression.
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