Compression with calcificaiton ???

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Hello people,

I have a little conundrum, would it be appropriate to apply compression therapy on clients whith clincally diagnosed calcified lower leg arteries.

I have a client with forefoot ulcerations, who is unable to be occluded when carrying out an ABPI. Diagnosed with macro/micro vascular calcification (X-ray). DNS are now trained to apply lower limb compression to all wound clients. I have advised against this therapy and i am unable to back up my clinical decision with any research. Can compression cause irriversable vascular collapse.??? Can anyone suggest any research papers on this topic.

Look forward to your responses.

Cheers

Nick...:santa2:

 

Very interesting question Nick.

Look forward to replies, if any.

 

from Australian and New Zealand Clinical Practice Guideline for Prevention and Management of Venous Leg Ulcers

This is a well referenced 136 page publication

 

As a 3rd year student my main areas of concern would be:
What level of oedema is present?
Is patient open to wearing compression? Any past history of use?
Would arterial profusion be restricted?
Would venous return be impaired.

Could try the compression and review on a regular basis with outcome measures. I hope not to appear nieve but I thought i'd try contributing for a change instead of just reading.

 

Interesting Question indeed.

Arteriosclerosis (calcification of arteries) is always accompanied with Atherosclerosis (plague formation) so it is important to check for perfusin in the distal parts. a toe pressure index or simply run a doppler probe over the toe tips to check for a pulse. Buergers test is a good way to determine perfusion (http://en.wikipedia.org/wiki/Buerger's_test).

High grade compression therapy is be used with caution in an ischemic foot (ABI < 0.6) but there is no evidence to support low grade compression to reduce the subcutaneous oedema is harmful in these patients. and there is no evidende high grade compression is safe in partients with an ABI > 1.2 or incompressible arteries. A compression bandage should have to be so tight that it would create a torniquet effect to cause irreversable arterial collapse. As Phil pointed out, your patients response and clinical signs should be a guide. For example if the toes goes purple or the patient says its getting painful.

It is found that in patients with venous ulcers (i dnt remember references on top of my head) that calf muslce strength and ankle joint torque and range of motion are reduced significantly compared to individuals with healed venous ulcers. i assume this would be true in patients with forefoot ulcers also. Mechanical compression is an effective treatment to manage venous pooling and wound exudate. Mechanical compression also improves arterial blood flow (see attached reference).

You could always request an angiogram assuming your patients reanl status is good for a comprehensive arterial map. But your clinical observation and signs (ABI, Perfusion, Capilary refill, colour, temperature and how the patient feel after compression) will always be the best indicator if compression shuld be used or to decide the grade of compression.

I hope this helps