title: Intermittent calf and foot compression increases lower extremity blood flow.
abstract: OBJECTIVE
  Although foot compression increases foot skin perfusion and calf compression increases popliteal artery blood flow, these compression techniques have not been evaluated in combination. The purpose of this study was to evaluate whether calf and foot compression applied separately and simultaneously increase popliteal artery blood flow and/or foot skin perfusion, and to assess the relative merits of compression in patients with superficial femoral artery occlusion.
  
  
  METHODS
  Twenty-two legs from 12 normal volunteers with ankle/brachial indices (ABIs) > 0.96, and 10 legs from 7 claudicator patients with angiographically documented superficial femoral artery (SFA) occlusion and patent popliteal arteries with ABIs < 0.8 were studied in the sitting position. Calf and foot cuffs connected to a rapidly inflating and deflating timed-pressure pump (Art-Assist-AA 1000; ACI Medical Inc., San Marcos, California) were applied to the subject in the sitting position. Skin blood flow of the great toe was measured with a laser doppler (Laserflo model BPM 403A; TSI Inc., St. Paul, Minnesota), and popliteal artery blood flow was measured using duplex ultrasonography (ATL-Ultramark 9; Advanced Tech Laboratory, Bothell, Washington). Foot and calf compression was applied separately and simultaneously at 120 mm Hg pressure, with a 10-second inflation and 20-second deflation cycle. Popliteal artery blood flow and foot skin perfusion were recorded and the mean of 6 cycles calculated.
  
  
  RESULTS
  Precompression popliteal artery blood flow (mL/min) for volunteers was 38.86 +/- 3.94, and for patients was 86.30 +/- 14.55 (P = 0.001). Precompression foot skin perfusion (mL/min/ 100/g tissue) for volunteers was 1.67 +/- 0.29, and for patients was 4.00 +/- 0.92 (P = 0.01). With the application of calf, foot, and simultaneous calf and foot compression, the popliteal artery blood flow increased in volunteers by 124%, 54%, and 173%, respectively, and in patients by 76%, 13%, and 50%. Foot skin perfusion increased in volunteers by 260%, 500%, and 328%, respectively, and in patients by 116%, 246%, and 188%. Relative increases in popliteal artery blood flow and foot skin perfusion were higher in volunteers compared with patients during compression; however, the absolute values for foot skin perfusion and popliteal artery blood flow were consistently higher in patients.
  
  
  CONCLUSIONS
  Measured in the sitting position, the resting popliteal artery blood flow and foot skin perfusion are greater in patients with SFA occlusion compared with normal volunteers. Following compression, popliteal artery blood flow and foot skin perfusion increased in both groups, but relatively more in volunteers. Increases in popliteal artery blood flow are significantly higher with calf compression than with foot compression for both groups. A patent SFA allows for additive increases in popliteal artery blood flow with simultaneous foot and calf compression in normal persons, whereas this is not observed in patients. However, the increases in foot skin perfusion in patients with an occluded SFA parallel the increases shown in normal volunteers, with separate and simultaneous foot and calf compression.
authors.affiliation: Department of Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania 19140, USA.
authors.forename: A R
authors.initials: AR
authors.lastname: Eze
authors.forename: A J
authors.initials: AJ
authors.lastname: Comerota
authors.forename: P L
authors.initials: PL
authors.lastname: Cisek
authors.forename: B S
authors.initials: BS
authors.lastname: Holland
authors.forename: R P
authors.initials: RP
authors.lastname: Kerr
authors.forename: R
authors.initials: R
authors.lastname: Veeramasuneni
authors.forename: A J
authors.initials: AJ
authors.lastname: Comerota
mesh_terms: D000328:Adult; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology*; D001783:Blood Flow Velocity; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005528:Foot / Q000098:blood supply; D006801:Humans; D007866:Leg / Q000098:blood supply* / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011312:Pressure; D012016:Reference Values; D012867:Skin / Q000098:blood supply; D014463:Ultrasonography