Compression in mixed ulcers: venous side

Abstract

Introduction: arterial involvement may coexist in about 15-30 of venous ulcers. In this case compression therapy maybe applied, only by expert caregivers, with a reduced pressure which must not overcome the arterial pressure at ankle and foot level. It remains to assess if such a reduced pressure may be effective also on the impaired venous hemodynamics. Aim of this paper is to present an overview of the data we have, showing the effects on venous hemodynamics of a reduced compression pressure.

Material and methods: in different groups of patients affected by deep and superficial venous incompetence, venous reflux and ejection fraction (EF) from the lower leg were measured in baseline conditions, without any compression, and after application of different elastic and inelastic compression devices exerting different pressure ranges from 20 to 60 mm Hg. The compression pressure was always recorded simultaneously with venous reflux of EF assessment.

Results: strong pressures show the greatest effect in reducing/abolishing venous reflux and increasing EF but also a reduced pressure in the range of 20 to 40 mm Hg is effective in improving venous hemodynamics provided inelastic materials are used.

Conclusions: inelastic but not elastic materials exert a standing pressure which is significantly higher than in supine position even starting from a reduced supine pressure of 40 mm Hg which does not impair the arterial inflow. This strong pressure is able to reduce and even abolish the venous reflux and improve the EF up to restoring its normal range. A reduced or modified compression pressure is able to significantly improve the venous hemodynamics without affecting the arterial inflow in patients with mixed ulcers, provided inelastic materials are used.

Keywords: ejection fraction; elastic compression; inelastic compression; mixed ulcers; venous hemodynamics; venous reflux.