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Randomized Controlled Trial
. 2011 Feb;35(2):446-54.
doi: 10.1007/s00268-010-0858-9.

Prospective randomized controlled trial to analyze the effects of intermittent pneumatic compression on edema following autologous femoropopliteal bypass surgery

Alexander te Slaa  1 , Dennis E J G J Dolmans, Gwan H Ho, Paul G H Mulder, Jan C H van der Waal, Hans G W de Groot, Lijckle van der Laan
Affiliations
Randomized Controlled Trial

Prospective randomized controlled trial to analyze the effects of intermittent pneumatic compression on edema following autologous femoropopliteal bypass surgery

Alexander te Slaa et al. World J Surg. 2011 Feb.

Abstract

Background: Patients who undergo autologous femoropopliteal bypass surgery develop postoperative edema in the revascularized leg. The effects of intermittent pneumatic compression (IPC) to treat and to prevent postreconstructive edema were examined in this study.

Methods: In a prospective randomized trial, patients were assigned to one of two groups. All patients suffered from peripheral arterial disease, and all were subjected to autologous femoropopliteal bypass reconstruction. Patients in group 1 used a compression stocking (CS) above the knee exerting 18 mmHg (class I) on the leg postoperatively for 1 week (day and night). Patients in group 2 used IPC on the foot postoperatively at night for 1 week. The lower leg circumference was measured preoperatively and at five postoperative time points. A multivariate analysis was done using a mixed model analysis of variance.

Results: A total of 57 patients were analyzed (CS 28; IPC 29). Indications for operation were severe claudication (CS 13; IPC 13), rest pain (10/5), or tissue loss (7/11). Revascularization was performed with either a supragenicular (CS 13; IPC10) or an infragenicular (CS 15; IPC 19) autologous bypass. Leg circumference increased on day 1 (CS/IPC): 0.4%/2.7%, day 4 (2.1%/6.1%), day 7 (2.5%/7.9%), day 14 (4.7%/7.3%), and day 90 (1.0%/3.3%) from baseline (preoperative situation). On days 1, 4, and 7 there was a significant difference in leg circumference between the two treatment groups.

Conclusions: Edema following femoropopliteal bypass surgery occurs in all patients. For the prevention and treatment of that edema the use of a class I CS proved superior to treatment with IPC. The use of CS remains the recommended practice following femoropopliteal bypass surgery.

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Figures

Fig. 1
Fig. 1
Trial profile. IPC intermittent pneumatic compression
Fig. 2
Fig. 2
Percent increase of averaged lower limb circumference with standard error markers. Differences between groups are significant on postoperative days 1, 4, and 7. *Significant difference between groups
Fig. 3
Fig. 3
Percent increase in C-reactive protein (CRP) concentration with standard error markers
Fig. 4
Fig. 4
Percent increase in leukocyte count with standard error markers
See this image and copyright information in PMC

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