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OBJECTIVES: The standard of care for the treatment of intermittent claudication (IC) is lifestyle modifications including smoking cessation and a weekly exercise regimen. Unfortunately, patient compliance remains an obstacle. Recently, intermittent pneumatic compression (IPC) pumps have been used as an adjunctive to current therapy. We looked at examining the real world applicability and outcomes on patients with claudication after IPC therapy.
METHODS: 46 patients with claudication (Ankle-Brachial Index, ABI ≤ 70) at the Harry S Truman VA Medical Center were prospectively managed with a recommended weekly exercise regiment, smoking cessation, and therapy with IPC pumps (Art Assit®) for 60-minutes three times-a-day for a period of three months. During this period of time a usage meter in the devices recorded actual usage. A retrospective chart review was conducted looking at clinical differences in resting ABI before and after IPC therapy, actual compliance with therapy, and intervention free outcomes.
RESULTS: 45.6% of all patients treated with IPC therapy noted subjective improvement in symptoms. Resting ABIs improved on average by 5% after therapy. Compliance was 34% of the total hours prescribed with the average patient only using IPC therapy for 45-minutes a day. All 46 patients were followed for a mean of 12.3 months. 28.2% of all patients that had undergone IPC therapy proceeded to any type of intervention. The most common type of intervention was angioplasty occurring within a mean of 5-months after therapy. While strict compliance to therapy was low at 8% it was associated with 100% of being intervention free at 1-year.
CONCLUSIONS: Our study shows that the applicability of IPC pumps in a clinical setting succumbs to poor compliance similar to that of smoking cessation and regimented standardized exercise. Regardless, IPC therapy, in all comers was associated with subjective improvement in almost half of all patients, an average 5% improvement in resting ABI, and a 71.8% chance of being intervention free at 1-year. The small percentage that was adherent to IPC therapy had a 100% chance of being intervention free at 1-year. We advocate the trial use of IPC therapy in clinical practice in conjunction with the standard of care in patients with non-limb threatening claudication.