The Use of Vacuum Compression Therapy on Ischemic Lower Limbs as Assessed by Changes in Venous Blood Gases and Serum Lactate

Abstract

Simple physical training, intermittent pneumatic compression, cardiosynchronous limb compression, pulsed short-wave radiofrequency, and external negative thigh pressure are all varieties of physiotherapeutic modalities used in the treatment of peripheral vascular disease.

A vacuum compression therapy (VCT) device allows both positive and negative pressure to be applied to an enclosed limb. Lower limbs of 13 consecutive patients suffering from chronic lower limb ischemia were exposed to alternating controlled periods of negative and positive pressure. The effect of this therapy was assessed by measurements of capillary oxygen saturation (by toe pulse oximetry), femoral venous blood gases, and whole blood lactate. These measurements were carried out at three time intervals: before, immediately after, and fifteen minutes after a fifteen-minute application of VCT to the affected limb.

The results showed evidence of deterioration in tissue perfusion immediately after treatment as evidenced by pulse oximetry and venous gases, followed, however, by a significant improvement in the same parameters when measured at fifteen minutes. These findings were consistent. The mean values at fifteen minutes as compared with resting values were as follows: oxygen saturation increased from 94.3 to 97.8% (P=0.002), venous PO₂ increased from 4.1 to 4.6 kPa (P=0.003), and venous PCO₂ returned to its original value at 6.6 kPa/L (P =0.003). Hydrogen ion concentration decreased from 41.6 to 40.6 nmol/L( P=0.003) and lactate decreased from 1 to 0.91 nmol/L (P=0.004).

It is, therefore, suggested that VCT may improve peripheral tissue perfusion. The immediate posttreatment biochemical deterioration was asymptomatic and may reflect a capillary washout phenomenon and/or a tourniquet effect created by the device's rubber cuff over the patient's thigh. Further studies monitoring clinical outcomes would be required before objective benefits for VCT therapy in peripheral vascular disease could be claimed.