Department of surgery, University College London Medical School
INTRODUCTION: Compression therapy is one of the most effective treatment modalities for chronic venous disease (CVD). Ischaemic damage to the leg may occur when compression therapy is used in patients with coexisting arterial disease.
AIM: To study the effect of increasing skin compression on the velocity of the skin blood flow in patients with combined disease.
MATERIAL & METHODS: 15 patients with CVD (CEAP clinical stage 4,5,6), 15 with arterial disease (ABPI 0.5-0.8) and 15 with combined arterial and venous disease were included. All had vascular duplex ultrasound and ankle brachial pressure assessment. Compression was applied to the skin using an acrylic disc at 10-mm Hg increments (10 to 100 mm Hg) in the supine and in the sitting positions. Average flow velocity in 5 capillaries 5 cm proximal to the medical malleolus was recorded using a laser capillary anemometer.
RESULTS: (Patient supine)
| Compression (mm Hg) | Median capillary velocity (IQR)-mm/s | Venous dis. n=15 | Arterial dis. n=15 | Combined dis. n=15 |
| 0 | 0.63 (0.31-0.85) | 0.62 (0.53-0.72) | 0.12 (0.09-0.16) |
| 20 | 1.2 (1.1-1.4) | 0.66 (0.43-0.73) | 0.23 (0.2-0.31) |
| 40 | 0.22 (0.15-0.32) | 0.38 (0.27-0.5) | 0.11 (0.08-0.14) |
| 60 | 1.8 (1.7-2.1) | 0.2 (0.07-0.21) | 0.07 (0.04-0.09) |
| 80 | 1.2 (0.98-1.4) | 0.0 (0.0-0.01) | 0.06 (0.03-0.07) |
| 100 | 0.94 (0.89-1.0) | 0.0 (0.0-0.0) | 0.04 (0.02-0.04) |
CONCLUSIONS: In patients with venous disease capillary flow velocity increased with low levels of compression (up to 40 mm Hg) and then decreased slowly. In patients with arterial disease, with or without venous disease, flow rapidly decreased to the low levels beyond 40 mm Hg. Compression therapy will have to be restricted to lower pressures when used to treat patients with combined venous and arterial disease.