Today's Wound Clinic - Winter 2008 - (Page 44) intech inflow into ischemic tissues. These devices work by enhancing the capacity for arterial inflow through the promotion of venous clearance/return. It is thought that the increased arteriovenous pressure gradient created after the leg veins empty and the decreased vascular resistance following compression, assist the cardiac system with perfusion of ischemic limb tissue. One of these therapies involves an end-diastolic pneumatic compression device. It compresses the legs after the heart beat and releases compression during systole to enhance filling of the leg arteries.19,20 Examples of pneumatic compression assist devices include the Circulator Boot™ (Circulator Boot Corp., Malvern, Pa) and the ArtAssist Device™ (ACI Medical, San Marcos, Calif). Evidence21 that this therapy is beneficial and some providers are reporting success with obtaining Medicare and Medicaid coverage of the device for their patients is increasing. use of pneumatic compression is evolving for all three disorders. A national coverage decision exists for the use of pneumatic compression therapy for lymphedema and chronic venous insufficiency after conservative therapy has failed. Clinicians also are reporting success in regards to obtaining coverage for high-pressure pneumatic compression therapy for peripheral arterial disease. Treatment approaches and parameters once based solely on expert opinion are being supported by research studies. There appears to be a role for the judicious use of pneumatic compression given the present state of evidence. ■ 10. Szuba A, Achalu R, and Rockson SG. Decongestive lymphatic therapy for patients with breast carcinoma-associated lymphedema. A randomized, prospective study of a role for adjunctive intermittent pneumatic compression. Cancer 2002;95(11):2260–2267. 11. Swedborg I. Effects of treatment with an elastic sleeve and intermittent pneumatic compression in post-mastectomy patients with lymphedema of the arm. Scand J Rehab Med. 1984;16:35-41. 12. Zelikovski A, Melamed I, Kott I, et al. The Lymphapress—a new pneumatic device for the treatment of lymphedema: Clinical trial results. Folia Angiologica. 1980; 41(2):165-169. 13. Johansson K, Lie E, Ekdahl C, Lindfeldt J. A randomized study comparing manual lymph drainage with sequential pneumatic compression for treatment of postoperative arm lymphedema. Lymphology. 1998;31:56–64. 14. Pappas CJ, O’Donnell TF Jr. Long-term results of compression treatment for lymphedema discussion. J Vasc Surg. 1992;16:555–556,562–564. REFERENCES 1. Association for the Advancement of Wound Care (AAWC). Summary algorithm for venous ulcer care with annotations of available evidence. Malvern, Pa: Association for the Advancement of Wound Care (AAWC); 2005:25. 2.Wound, Ostomy, and Continence Nurses Society (WOCN). Guideline for management of wounds in patients with lowerextremity venous disease. Glenview, Ill: Wound, Ostomy, and Continence Nurses Society (WOCN); 2005:42 3. Lymphedema Pumps. Available at www.bcbsms.com/index.php?id=202&path=/ policy/emed/Lymphedema_Pumps.html 4. Center for Medicare and Medicare Services. Available at www.cms.hhs.gov/mcd/viewncd. asp?transmittals/downloads/R151CIM.pdf 5. Centers for Medicare and Medicaid Services. Available at www.cms.hhs.gov/mcd/viewncd. asp?ncd_version=1&basket=ncd%3A280%2E 6%3A1%3APneumatic+Compression+Devices 6.TriCenturion. Pneumatic compression devices.doc. www.tricenturion.com/searchRsult.cfm 7. Eliska O, Eliskova M.Are peripheral lymphatics damaged by high pressure manual massage? Lymphology. 1995;29:121–30. 8. Moseley AL, Carati CJ, Piller NB. A systematic review of common conservative therapies for arm lymphoedema secondary to breast cancer treatment. Ann of Oncology. 2007;18(4):639-646. 9. Dubois F. Comparison between applying manual lymphatic drainage only, applying sequential pressotherapy by Lympha-Press itself and the combination of using both applications. Available at www.lymphapress.com/pdf/phystreatment.pdf. 15. Dini D, L Del Mastro, A Gozza, et al.The role of pneumatic compression in the treatment of postmastectomy lymphedema. A randomized Phase III study. Ann Oncol. 1998;9:187-190. 16. Bergan J, Sparks S, Angle N. A comparison of compression pumps in the treatment of lymphedema. Vasc and Endova Surg.1998;32(5): 455-462. 17. Berliner E, Ozbilgin B, Zarin DA. A systematic review of pneumatic compression for treatment of chronic venous insufficiency and venous ulcers. J Vasc Surg. 2003; Mar; 37(3):539-544. 18. Rowland J. Intermittent pump versus com pression bandages in the treatment of leg ulcers. Austral and New Zealand J Surg. 2000;70(2):110–113. 19. Dillon RS. Fifteen years of experience in treating 2,177 episodes of foot and leg lesions with the circulator boot. Angiology. 1997; 48:S17-S34. 20. Dillon RS. Effect of therapy with the pneumatic end-diastolic leg compression boot on peripheral vascular test and on the clinical course of peripheral vascular disease. Angiology. 1980; 31:614-38. 21. Louridas G, Saadia R, Spelay J,Abdoh A, et al. The ArtAssist Device in chronic lower limb ischemia. A pilot study. Int. Angiology. 2002;21 (1):28-35. 22. Boris M, Weindorg S, Lasinski BB, et all. The risk of genital lymphedema after external pump compression for lower limp lymphedema. Lymphology, 1998;Mar;31(1):15–20. 23. Brennan MJ. Lymphedema Following the Surgical Treatment of Breast Cancer: Review of Pathophysiology and Treatment, Journal of Pain and Symptom Management 1992;7:110-116. ADVERSE EVENTS WITH PNEUMATIC COMPRESSION THERAPY Expert opinion indicates that high levels of compression may damage the fragile lymphatics in the dermis.7 Boris et al, also reported that treatment of CVI with pneumatic compression pumps increases the risk of genital edema.22 However, it should be noted that the pressures utilized in this study where double those recommended for individuals with lymphedema so the risk for genital edema may be less when using a lympehdema protocol for compression pump application. others have also recommended against the use of compression pumps in the presence of infection, metastatic disease and ongoing radiation.23 CONCLUSION Pneumatic compression therapy is being used to treat chronic vascular problems including lymphedema, venous insufficiency, and arterial insufficiency. Evidence supporting the 44 Winter 2008 Today’s Wound Clinic http://www.bcbsms.com/index.php?id=202&path=/policy/emed/Lymphedema_Pumps.html http://www.cms.hhs.gov/mcd/viewncd.asp?transmittals/downloads/R151CIM.pdf http://www.cms.hhs.gov/mcd/viewncd.asp?transmittals/downloads/R151CIM.pdf http://www.cms.hhs.gov/mcd/viewncd.asp?ncd_version=1&basket=ncd%3A280%2E6%3A1%Pneumatic+Compression+Devices http://www.cms.hhs.gov/mcd/viewncd.asp?ncd_version=1&basket=ncd%3A280%2E6%3A1%Pneumatic+Compression+Devices http://www.tricenturion.com/searchRsult.cfm http://www.lymphapress.com/pdf/phystreatment.pdf http://www.lymphapress.com/pdf/phystreatment.pdf
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