Despite numerous advances in interventional radiology and
vascular surgery, the clinician continues to be confronted with inoperable
vascular disease. Previous studies have shown that ulceration associated with a transcutaneous
oxygen pressure (tcPO2) of <20 mmHg is refractory to all attempts at healing. External pneumatic compression for the treatment of
peripheral vascular disease has been available for several years, although there is a relative paucity of data regarding its role in clinical practice as well as its efficacy. The objective of this study was to examine the experience with circulator boot
therapy in the treatment of ischemic
ulcers in the absence of
osteomyelitis, and specifically to determine whether such
therapy can be of benefit in ischemic limb ulceration associated with a tcPO2 of <20 mmHg. A retrospective chart review was undertaken of ail patients with a lower limb
ulcer who, in the absence of
osteomyelitis, underwent circulator boot
therapy at the Gonda Vascular Center. A total of 98 patients was identified. Two patients died within 1 month of commencing
therapy and were not included in further analysis. The tcPO2 data were unavailable in five patients. Outcome in the patient population was classified as favorable if (1)healing was achieved, (2)the
ulcer decreased in size, or (3) the affected limb improved sufficiently to allow successful revascularization. An unfavorable outcome was one where a major
amputation was performed or where the
ulcer increased in size. Out of a total of 29 patients with a tcPO2 <20 mmHg at the area of ulceration, 19 had a favorable outcome following circulator boot
therapy. Of the remaining 62 patients with a tcPO2 >20 mmHg, 54 had a favorable outcome. Circulator boot
therapy is associated with improved outcomes in limb ulceration due to
peripheral vascular disease. Complete
ulcer healing as well as preservation of the affected limb can be achieved in most cases.