Treatment of non-reconstructable PVD with the Arterial Assist Device

Paul S. van Bemmelen, MD, Stony Brook, NY and Valerie A. Brunetti, DPM, Northport, NY
 
   
  • 68 y.o. male with diabetes
  • 4-month history of rest pain and progressive necrosis
  • PVR's were diminished, flat wave form at toe level
  • No run-off towards the toe
   
  • Applied intermittent compression to foot, ankle and calf at 120mmHg
  • Home use 1 hour, q.i.d.
  • Metatarsal PVR-amplitude increased
  • The lesions are almost healed (second toe completely healed)
 
     
 
Figure 1
 
Figure 2
 
Figure 3
  Patient is a 68 year-old man with diabetes; status post Coronary Artery Bypass Graft (CABG), Carotid Endarterectomy (CEA) and bilateral femoro-popliteal bypass and bilateral profundaplasty. Patient presented with a 4-month history of rest-pain and progressive necrosis of the right hallux (figure 1). A small lesion was developing on the tip of the second toe. Non-invasive pulse-volume recording (PVR) demonstrated a diminished amplitude of 3mm at the metatarsal level, with a flat waveform at the toe level. Arteriography demonstrated patent vessels down to the ankle, but no run-off towards the forefoot (figure 2). Patient used ArtAssist® compression for one hour, q.i.d. Topical treatment consisted of a non-adherent dressing only and minor debridements in the office. After completion of a 3-month compression protocol, the lesions were almost healed (figure 3). Metatarsal PVR-amplitude increased to 9mm. Note the tip of the second toe, which was already healed after one month.

ArtAssist® can increase skin-flow more than 4 times.1,2

UPDATE: COMPLETELY HEALED
 
References:
1. van Bemmelen PS, Weiss-olmanni J, Ricotta JJ: Rapid intermittent compression increases skin circulation in chronically ischemic legs with infra-popliteal obstruction. VASA 2000;29:47-52.
2. Eze AR, comerota AJ, et al. Intermittent calf and foot compression increases lower extremity blood flow. Am J Surg. 1996;172:130-135.
ArtAssist®, VenAssist®, VenaPulse®, and APG® are register trademarks of ACI Medical, Inc., San Marcos, CA, USA.