title: Improved hemodynamic effectiveness and associated clinical correlations of a new intermittent pneumatic compression system in patients with chronic venous insufficiency.
abstract: OBJECTIVE
  A new intermittent pneumatic compression device (SCD Response System) has recently been shown in healthy volunteers to have the ability to detect the postcompression refilling of the calf veins and to respond by initiating the subsequent cycle when these veins are full. This has proven to be more effective in expelling blood proximally than the conventional intermittent pneumatic compression device (SCD Sequel System). The aim of this study was to test the influence of venous disease on the postcompression refill time detected by means of the SCD Response and the effectiveness of the new system in expelling blood in patients who have venous reflux caused by post-thrombotic syndrome or varicose veins.
  
  
  METHODS
  This open, controlled trial was conducted in an academic vascular unit with 10 patients who had post-thrombotic syndrome and 10 patients who had varicose veins. The new SCD Response System was tested against the existing SCD Sequel System in both legs in the supine, semirecumbent, and sitting positions. The refilling time sensed by means of the device was correlated with the venous filling index by using air plethysmography. The total volume of blood expelled per hour during compression was compared with that expelled by the SCD Sequel System in the same volunteers and in the same positions.
  
  
  RESULTS
  An inverse association was found between the mean postcompression refilling time in the sitting position and the venous filling index of the apparently healthy or less severely affected leg (r = -0.52, P =.019), the refill time being significantly shorter in patients with advanced venous disease. The SCD Response System increased the volume expelled per hour in the post-thrombotic leg, when compared with the SCD Sequel System, by 109.9% (P =.005) in the supine position, by 85.1% (P =.009) in the semirecumbent position, and by 40.2% (P =.005) in the sitting position. The corresponding results in the more severely affected leg in patients with varicose veins were 71.9% (P =.005) in the supine position, 77.9% (P =.005) in the semirecumbent position, and 55.7% (P =.013) in the sitting position. Similar improved results were also found in the contralateral leg in both groups.
  
  
  CONCLUSIONS
  The deflation settings of the new SCD Response System are able to be adjusted selectively, correlating with the physiological severity of chronic venous insufficiency. By achieving more frequent compression cycles, the new system is more effective than the current one in expelling blood proximally, confirming our earlier findings in healthy volunteers. Further studies testing a possible improved efficacy in preventing deep venous thrombosis in this high-risk group are justified.
authors.affiliation: Irvine Laboratory for Cardiovascular Investigation and Research, Department of Vascular Surgery, Imperial College School of Medicine, St. Mary's Hospital, London, United Kingdom. s.kakkos@ic.ac.uk
authors.forename: S K
authors.initials: SK
authors.lastname: Kakkos
authors.forename: G
authors.initials: G
authors.lastname: Szendro
authors.forename: M
authors.initials: M
authors.lastname: Griffin
authors.forename: M M
authors.initials: MM
authors.lastname: Sabetai
authors.forename: A N
authors.initials: AN
authors.lastname: Nicolaides
mesh_terms: D001783:Blood Flow Velocity; D005676:Gravity Suits; D006439:Hemodynamics; D006801:Humans; D007866:Leg / Q000098:blood supply; D010991:Plethysmography; D011186:Postphlebitic Syndrome / Q000150:complications / Q000503:physiopathology; D011187:Posture; D013997:Time Factors; D014648:Varicose Veins / Q000150:complications / Q000503:physiopathology; D014689:Venous Insufficiency / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*