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Schwahn-Schreiber C, Breu FX, Rabe E, Buschmann I, Döller W, Lulay GR, Miller A, Valesky E, Reich-Schupke S. [S1 guideline on intermittent pneumatic compression (IPC)]. Hautarzt 2019; 69:662-673. [PMID: 29951853 DOI: 10.1007/s00105-018-4219-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Under the direction of the German Society of Phlebology (Deutsche Gesellschaft für Phlebologie) and in cooperation with other specialist associations, the S1 guideline on intermittent pneumatic compression (IPC) was adopted in January 2018. It replaces the previous guideline from March 2005. The aim of the guideline is to optimize the indication and therapeutic use of IPC in vascular diseases and edema. An extensive literature search of MEDLINE, existing guidelines, and work relevant to the topic was performed. In view of the often methodologically weak study quality with often small numbers of cases and heterogeneous treatment protocols, recommendations can often only be derived from the available data using good clinical practice/expert consensus. Intermittent pneumatic compression is used for thromboembolism prophylaxis, decongestive therapy for edema, and to positively influence arterial and venous circulation to improve clinical symptoms and accelerate ulcer healing in both the outpatient and inpatient care setting. The therapy regimens and devices used depend on the indication and target location. They can be used as outpatient and inpatient devices as well as at home for long-term indications. A target indication is thrombosis prophylaxis. IPC should be used in severe chronic venous insufficiency (stages C4b to C6), in extremity lymphedema as an add-on therapy and in peripheral arterial occlusive disease (PAOD) with stable intermittent claudication or critical ischemia. IPC can be used in post-traumatic edema, therapy-resistant venous edema, lipedema and hemiplegia with sensory deficits and edema. Absolute and relative contraindications to IPC must be taken into account and risks considered and avoided as far as possible. Adverse events are extremely rare if IPC is used correctly. If the indication and application are correct-also as an add-on therapy-it is a safe and effective treatment method, especially for the treatment of the described vascular diseases and edema as well as thrombosis prophylaxis.
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Affiliation(s)
| | - F X Breu
- Venenzentrum am Tegernsee, Tegernseerstr.3, 83703, Gmund am Tegernsee, Deutschland
| | - E Rabe
- Klinik und Poliklinik für Dermatologie, Sigmund Freud Str. 25, 53105, Bonn, Deutschland
| | - I Buschmann
- Klinik für Innere Medizin I - Kardiologie, Pulmologie, Angiologie, Städtisches Klinikum Brandenburg GmbH, Hochstr. 29, 14770, Brandenburg an der Havel, Deutschland
| | - W Döller
- , Ingeborg Bachmann-Weg 11, 9400, Wolfsberg, Österreich
| | - G R Lulay
- Klinik für Gefäß- und Endovaskularchirurgie - Phlebologie - Lymphologie - Gefäß- und Lymphzentrum Nord-West, Klinikum Rheine/Mathias-Spital, Frankenburgstr. 31, 48341, Rheine, Deutschland
| | - A Miller
- die hautexperten, Praxis, Wilmersdorfer Str. 62, 10627, Berlin, Deutschland
| | - E Valesky
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
| | - S Reich-Schupke
- Klinik für Dermatologie, Venerologie und Allergologie, Venenzentrum der Dermatologischen und Gefäßchirurgischen Kliniken, Ruhr-Universität Bochum, Hiltroper Landwehr 11-13, 44805, Bochum, Deutschland
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O'Sullivan-Drombolis DK, Houghton PE. Pneumatic compression in the treatment of chronic ulcers. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/174328809x405955] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Rathbun SW, Kirkpatrick AC. Treatment of chronic venous insufficiency. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2007; 9:115-26. [PMID: 17484814 DOI: 10.1007/s11936-007-0005-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Chronic venous insufficiency (CVI) results from venous hypertension secondary to superficial or deep venous valvular reflux. Treatment modalities are aimed at reducing venous valvular reflux, thereby inhibiting the ensuing pathologic inflammatory process. Compression therapy using pumps, bandaging, and/or graded compression stockings is the mainstay of treatment for CVI. Compression therapy has been shown to be effective in reducing venous hypertension retarding the development of inflammation and pathologic skin changes. Pharmacologic agents such as diuretics and topical steroid creams reduce swelling and pain short term but offer no long-term treatment advantage. Herbal supplements may reduce the inflammatory response to venous hypertension, but are not licensed by the US Food and Drug Administration, and vary in their efficacy, quality, and safety. However, several randomized controlled trials using the herbal horse chestnut seed extract containing aescin have shown short-term improvement in signs and symptoms of CVI. Endovascular and surgical techniques aimed at treatment of primary and secondary venous valvular reflux have been shown to improve venous hemodynamics promoting healing of venous ulcers and improving quality of life. The newer endovascular treatments of varicose veins using laser, radiofrequency ablation, and chemical foam sclerotherapy show some promise.
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Affiliation(s)
- Suman W Rathbun
- Department of Medicine, Cardiovascular Section, University of Oklahoma Health Sciences Center, 920 Stanton L. Young Boulevard, WP 3120, Oklahoma City, OK 73104, USA.
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Kalodiki E. Use of intermittent pneumatic compression in the treatment of venous ulcers. Future Cardiol 2007; 3:185-91. [DOI: 10.2217/14796678.3.2.185] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Venous ulcers affect up to 1% of the population. This review provides the hemodynamic, hematologic and clinical effects of intermittent pneumatic compression (IPC) in the treatment of venous ulcers. It presents the different IPCs and their application on venous disease. It points out that a large randomized study on IPC versus standard four-layer compression in the treatment of venous ulcers is needed. The cost–effectiveness of IPC in the treatment of venous ulcers should also be assessed.
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Affiliation(s)
- Evi Kalodiki
- Imperial College & Vascular Surgery Department, Ealing Hospital, London, UK
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