The home use of external pneumatic compression for the management of chronic venous insufficiency

Objective. To prospectively evaluate the clinical and hemodynamic response to sequential gradient pneumatic compression (SGPC) at home, in conjunction with elastic stockings, for the management of patients with chronic venous insufficiency (CVI). Experimental design. Prospective study with a six-month follow-up. Setting. University affiliated community hospital. Patients. A group of 18 consecutive outpatients with non-ulcerated CVI confirmed by duplex scanning and photoplethysmography. Average age was 45.1 (range: 23 to 62). Intervention. All patients were instructed to use SGPC at home for four hours a day, in addition to the use of elastic compression stockings, during six months. Measures. 1) Clinical improvement based on a scoring system. 2) Compliance and tolerance to home use of SGPC. 3) Air plethysmography (APG) which was performed on 20 legs, before SGPC treatment and one, three, and six months after beginning compression therapy. Results. Home use of SGPC was implemented an average of 2.14 hours a day for 6.5 days per week. The median total score of severity of symptoms was 20 (IQR 17.2-25) before treatment and 13 (IQR 10-16.5) thereafter (p<0.001). Overall, 75% and 60% of patients felt that their standing ability and activity tolerance had improved, respectively. The compliance to and tolerance of SGPC was rather good. With regard to APG, there was a significant increase in the ejection fraction (p<0,001) paralleled by a reduction in the residual volume fraction after three and six months of home compression. Conclusions. In a group of patients with confirmed deep chronic venous insufficiency, the home use of sequential gradient pneumatic compression at home, in addition to elastic stockings, achieved significant clinical improvement and induced a favorable hemodynamic response, as measured by air plethysmography.