Intermittent pneumatic compression has been used for a number of indications, and is currently employed in the US as an adjunctive for the prophylaxis of nosocomial deep vein thrombosis. Since the underlying cause of venous ulceration is postulated to involve deficient blood return in the calf muscle pump, it has been suggested that intermittent pneumatic compression could improve the healing rates of venous ulcers by improving venous return.
Intermittent pneumatic compression for the treatment of venous ulcers has been the subject of a Cochrane collaborative review.39 This review evaluated four randomised controlled trials of intermittent pneumatic compression for the treatment of venous ulcers. One trial of 45 patients compared intermittent pneumatic compression plus standard limb compression with standard limb compression alone, and found a significant benefit in the intermittent pneumatic compression plus standard compression group, with a relative risk of healing of 11-4 (CI 1-6-82). Two other small trials (including 75 people altogether) failed to find a significant benefit of intermittent pneumatic compression plus standard compression over standard compression alone. Notably, the duration of therapy with intermittent pneumatic compression in these trials varied considerably. Moreover, the study endpoints differed substantially, ranging from 3 to 6 months. Results of these trials were therefore not pooled by the Cochrane group. One small study compared intermittent pneumatic compression alone (i.e. without standard compression) with standard compression, and failed to show a significant difference between the groups. The Clinical Evidence group pooled the results of a study published after the systematic review with the results of the above studies but failed to demonstrate a significant benefit of intermittent pneumatic compression.3,40
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