3Ĭompression pumps consist of an inflatable boot and a pneumatic pump that fills the boot with compressed air. Static compression is thought to help reduce the pressure in the veins by aiding venous return. Stockings, bandages other similar systems provide static compression compared to the intermittent compression provided by pneumatic compression devices. There are a number of methods that can be used to apply compression: elastic bandages, Unna boots, compression bandages or stockings which provide gradient pressure, compression pumps and orthotic devices. Compression facilitates wound healing, reduces venous dermatitis, improves lipodermatosclerosis and counteracts venous hypertension. There is wide consensus in the literature that compression is a necessary part of treatments for CVI and venous ulcers. These types of failures result in ambulatory venous hypertension that alters the microcirculation, causing ulceration. Neuromuscular disorders or arthritis can affect the calf muscle pump function. In a small number of cases, there is obstruction of the deep veins rather than valvular incompetence. 2 Fewer than 10 percent of venous ulcers are due to deep venous incompetence alone. Up to 40 to 50 percent of venous ulcers are caused by superficial venous insufficiency and/or perforating vein incompetence alone with normal deep vein. Studies of the prevalence of venous leg ulcers found that venous ulcers occur in approximately 0.18-1.3% of the adult population.
Are sequential compression devices used for edema skin#
Approximately 3-11% of the adult population has skin changes and edema due to CVI. Symptoms and signs of CVI include hyperpigmentation, statis dermatitis, chronic edema and venous ulcers. The venous circulation is a complex system that depends on the functions of muscle, valve and veins.ĬVI is distinguished from lymphedema in that lymphedema is when the lymphatic system is not able to clear fluid from the interstitial tissues of the body and return it to the bloodstream via a system of lymphatic vessels and lymph nodes. One-way valves in the veins impede an outward flow through the perforators and prevent reflux during diastole. When muscles relax, the diastole phase, the pressure falls in the deep system and blood flows from the superficial veins to the deep veins through the communicating veins due to pressure differences.
During muscle contraction (systole), the muscles exert high pressure on the deep venous system and milk the blood toward the proximal veins. Two major pumps propel the blood centrally: the cardiac pump and the muscle pump.
The blood flows from the superficial to the deep system through perforating veins upward toward the heart valves impede reflux. 1 The venous system in the lower extremities is composed of a superficial venous system, a deep venous system within fascia, and a connecting perforating system.
Clinical BackgroundĬhronic venous insufficiency (CVI) of the lower extremities is a condition caused by abnormalities of the venous wall and valves, leading to obstruction or reflux of blood flow in the veins. This memorandum serves four purposes: (1) outlines the description and treatment of chronic venous insufficiency (2) reviews the history of Medicare's national coverage policies for pneumatic compression pumps for the treatment of generalized refractory edema from venous insufficiency (3) presents and analyzes the relevant clinical and scientific data related to the use of pneumatic compression pumps for venous insufficiency, and (4) delineates the rationale for our decision not to make any changes to this portion of the national coverage determination. Medical Officer, Division of Items and Devices Policy Analyst, Division of Items and Devices Pneumatic Compression Devices for the treatment of generalized, refractory edema from venous insufficiency
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