Sequential Pneumatic Compression Biomechanical Home Therapy Device in the Management of Critical Lower Limb Ischemia for No-Option Patients

Critical limb ischemia (CLI) causes pain, skin ulcers, and sores, and it leads to an unacceptable quality of life. Sequential pneumatic compression (SPC) has been proposed as an adjunct to best medical care, aimed at preventing amputation, relieving pain, and promoting wound healing by recruiting the nonfunctional capillary bed and increasing blood flow in distal limbs. Our tertiary referral center conducted a study to determine the efficacy of SPC in patients with CLI between 2005 and 2015, where patients were commenced on a 12-week treatment protocol. Sustained clinical improvement was 68% at 1 year. Thirty-day mortality was 0.6%. Limb salvage was 94% at 5 years. Freedom from major adverse clinical events was 62.5% at 5 years. All-cause survival was 69% at 4 years. From 2010 to 2015, 20 limbs (7.6%) underwent major amputation out of the 262 limbs studied. Amputation-free survival was 98% for those who acquired the device and 90% for those who did not at 6 months, and 96% and 84% at 1 year, respectively. SPC is a valuable tool in the armamentarium for CLI therapy. It achieves rapid relief of rest pain without any intervention in patients with limited life expectancy. It reduces minor amputations and adjourns major amputations, although it does not significantly lessen the incidence of inevitable limb loss.