Docstoc

preuves expérimentales . CM JIFA 2009 H PARTSCH

Document Sample
preuves expérimentales . CM  JIFA 2009  H PARTSCH Powered By Docstoc
					EXPERIMENTAL PROFF FOR THE EFFICACITY OF COMPRESSION DEVICES
JIFA 2009


Hugo Partsch
Prof. Dr Hugo Partsch
Baumeistergasse 85
A 1160 Vienna /Austria
Hugo.Partsch@meduniwien.ac.at


Compression therapy is a treatment modality which is based on experience dating back
thousands of years. Some scientific initiatives to proof the effects of compression have
started only during the last decades. Randomized controlled trials have been done in different
indications and experimental studies were performed in order to evaluate the mode of action
of compression therapy.
In a consensus meeting organized by the International Compression Club (ICC) in September
2008 in Lucca, Italy, a list of clinical methods have been discussed which can be used to
demonstrate several effects of compression in patients suffering from venous and lymphatic
disorders of the extremities ( see: www.icc-compressionclub.com).
One prerequisite for assessing different compression effects is the measurement of pressure
under a bandage or stocking. Today there are several systems available which fulfil the
technical requirements postulated in a previous ICC document (1). Measuring the sub-
bandage pressure under bandages can also give important information concerning the elastic
properties of different materials and of bandages consisting of various combinations of
textiles. Using combined kits of bandages or stockings it is proposed to use rather the term of
stiffness instead of „elastic“ and „inelastic“(2).
The relationship between dosage (compression pressure) and outcome concerning several
compression effects has poorly investigated up to now. Using high frequency ultrasound
investigations of the skin it could be demonstrated that oedema can be reduced already with
compression stockings exerting relative low external pressure. The same was demonstrated by
water displacement volumetry, but also with several optoelectronic methods (Perometer®).
Light medical compression stockings are able to prevent leg swelling after prolonged sitting
or standing. Experimental studies in lymphoedema patients were able to demonstrate
considerable volume reduction especially after intermittent pneumatic compression (IPC) and
after short stretch bandages.
The question of venous narrowing by compression is still a controversial point depending
very much on the body position. Duplex ultrasound, CT and MRI are valuable methods to
give clear answers. In the lying position thromboprophylactic stockings exerting a pressure on
the distal lower leg around 15 mm Hg are able to narrow superficial and deep veins.
During standing and walking much higher pressure is needed to reduce venous diameters.
Valid parameters for a hemodynamic ally significant narrowing of veins can be obtained by
measuring venous reflux and venous pumping function. Venous reflux in different venous
segments can be assessed by Duplex-ultrasound. Several plethysmographic methods can be
used to measure global venous reflux (e.g... air plethysmography-APG). Phlebodynamometry
is the gold-standard for measuring venous pumping function. Some plethysmographic
techniques offer a non-invasive alternative. In patients with chronic venous insufficiency it
could be shown by foot-volumetry that compression stockings reveal an increasing
improvement of venous pumping efficacy with increasing compression pressure. To reduce
ambulatory venous hypertension in patients with massive venous reflux short stretch bandages
exerting a resting pressure of around 50 mm Hg are necessary. With the same resting pressure
inelastic material is more effective than elastic.
The deciding end-organ of the microcirculation has only been poorly investigated concerning
the efficacy of compression. By measuring the intracapillary pressure it could be shown that
compression is able to reduce venular hypertension. There is a reduction of fluid extravasation
into the tissue, an improvement of the nutritional flow of the skin. Beneficial effects
concerning an increased release of anti-inflammatory, anti-thrombotic, and vasodilating
mediators from the venular endothelium could be demonstrated using IPC.
Up to now compression was mainly considered to reduce arterial inflow. The danger to
damage the skin in patients with (unrecognized) arterial occlusive disease has to be taken into
account especially when sustained compression is applied using elastic material. Based on
different measuring methods there is increasing evidence that intermittent compression
exerting high pressure peaks is able to increase arterial flow even in patients with severe
arterial occlusive disease. These experimental results should promote the future development
of compression devices exerting a low resting pressure and high pressure peaks during
walking for the large group of patients with mixed arterial-venous ulcers.
References can be found in a recently published ICC consensus paper (3).


References
1. Partsch H, Clark M , Bassez S , Becker F; Benigni JP; Blazek V , Caprini J , Cornu-
Thénard F , Hafner J , Flour M , Jünger M ,Moffatt Ch ,Neumann HAM
Measurement of lower leg compression in vivo:Recommendations for the performance of
measurements of interface pressure and stiffness: A consensus statement. Dermatol Surg.
2006;32:229-38
2. Partsch H, Clark M, Mosti G, Steinlechner E, Schuren J, Abel M, Benigni JP, Coleridge-
Smith P, Cornu-Thénard A, Flour M, Hutchinson J, Gamble J, Issberner K, Juenger M,
Moffatt C, Neumann HA, Rabe E, Uhl JF, Zimmet S. Classification of compression bandages:
practical aspects. Dermatol Surg. 2008 May;34(5):600-9.
3. Partsch H, Flour M, Smith PC , Benigni JP, Cornu-Thénard A, Delis K, Gniadecka M,
Mariani F, Mosti G, Neumann HAM, Rabe E, Schuren J, Uhl JF. International Compression
Club. Indications for compression therapy in venous and lymphatic disease consensus based
on experimental data and scientific evidence. Under the auspices of the IUP. Int Angiol. 2008
Jun;27(3):193-219.

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:14
posted:4/5/2012
language:
pages:3