title: Non-Invasive Management of Peripheral Arterial Disease.
abstract: Peripheral arterial disease (PAD) is common and symptoms can be debilitating and lethal. Risk management, exercise, radiological and surgical intervention are all valuable therapies, but morbidity and mortality rates from this disease are increasing. Circulatory enhancement can be achieved using simple medical electronic devices, with claims of minimal adverse side effects. The evidence for these is variable, prompting a review of the available literature.
  
  
  
  Embase and Medline were interrogated for full text articles in humans and written in English. Any external medical devices used in the management of peripheral arterial disease were included if they had objective outcome data.
  
  
  
  Thirty-one papers met inclusion criteria, but protocols were heterogenous. The medical devices reported were intermittent pneumatic compression (IPC), electronic nerve (NMES) or muscle stimulators (EMS), and galvanic electrical dressings. In patients with intermittent claudication, IPC devices increase popliteal artery velocity (49-70 %) and flow (49-84 %). Gastrocnemius EMS increased superficial femoral artery flow by 140 %. Over 4.5-6 months IPC increased intermittent claudication distance (ICD) (97-150 %) and absolute walking distance (AWD) (84-112 %), with an associated increase in quality of life. NMES of the calf increased ICD and AWD by 82 % and 61-150 % at 4 weeks, and 26 % and 34 % at 8 weeks. In patients with critical limb ischaemia IPC reduced rest pain in 40-100 % and was associated with ulcer healing rates of 26 %. IPC had an early limb salvage rate of 58-83 % at 1-3 months, and 58-94 % at 1.5-3.5 years. No studies have reported the use of EMS or NMES in the management of CLI.
  
  
  
  There is evidence to support the use of IPC in the management of claudication and CLI. There is a building body of literature to support the use of electrical stimulators in PAD, but this is low level to date. Devices may be of special benefit to those with limited exercise capacity, and in non-reconstructable critical limb ischaemia. Galvanic stimulation is not recommended.
authors.affiliation: Section of Surgery, Imperial College London, London, UK.
authors.forename: K J
authors.initials: KJ
authors.lastname: Williams
authors.affiliation: Section of Surgery, Imperial College London, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Babber
authors.affiliation: Section of Surgery, Imperial College London, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Ravikumar
authors.affiliation: Section of Surgery, Imperial College London, London, UK. a.h.davies@imperial.ac.uk.|Charing Cross Hospital, 4th Floor, Fulham Palace Road, London, W6 8RF, UK. a.h.davies@imperial.ac.uk.
authors.forename: A H
authors.initials: AH
authors.lastname: Davies
mesh_terms: D019468:Disease Management; D004599:Electric Stimulation Therapy / Q000379:methods*; D005263:Femoral Artery / Q000473:pathology; D006801:Humans; D007383:Intermittent Claudication / Q000473:pathology / Q000628:therapy*; D048228:Intermittent Pneumatic Compression Devices; D058729:Peripheral Arterial Disease / Q000473:pathology / Q000628:therapy*; D011788:Quality of Life; D014160:Transducers, Pressure; D020246:Venous Thrombosis / Q000473:pathology / Q000628:therapy*
keywords: Chronic venous disease; DVT; Electrical stimulation; NMES; Pulmonary embolism; Thrombosis