Peripheral Artery Disease. Double Focal Compression Bandaging Technique
Carlos Sánchez Fernández de la Vega*
Fingoi Centre/Primary Care-Galego Health Service, Lugo, Spain
*Corresponding Author: Carlos Sánchez Fernández de la Vega, Fingoi Centre/Primary Care-Galego Health Service, Lugo, Spain.
Received: May 29, 2023;
Published: June 28, 2023
When applying compression bandaging to a leg with a vascular ulcer, one of the biggest fears of professionals is that they may not detect severe peripheral artery disease. Measuring the ankle-arm index is a crucial diagnostic tool for the detection of this disease. According to the guidelines for treating peripheral arterial disease, compression therapy is contraindicated, without clinical evaluation by a vascular expert, when this index is below 0.80. Double focal compression bandage technique is a type of compression therapy, based on physiological principles such as arteriogenesis and angiogenesis, which uses only bandages and gauze, to obtain pressure gradients that stimulate collateral circulation in the affected area, leading to healing of the vascular ulcer. It is now recognized that compression is not a contraindication for patients whose ankle-brachial index is at least 050, but the clinical course of the ulcer should be monitored daily, in the first weeks. This article describes the clinical evolution of arterial ulcers in the legs, in five patients diagnosed with severe peripheral arterial disease, where the compression bandaging was contraindicated, according to angiologists who had already treated them. Since the various treatments had failed, I decided to use this technique, which was successful. Daily monitoring of clinical course during the first few weeks is required, to detect signs/symptoms of worsening, we taught patients how to detect them, in which case themselves would remove the bandaging and come to the medical office. The fourth case is a patient diagnosed with Leriche syndrome, who has undergone several surgeries to restore circulation in the legs. The surgical options are over, the next treatment would be amputation. We applied the technique, for 2.5 months, to reduce oedema and heal the wound of the amputated toe. The patient reduced the oedema and healed the wound, but he worsened, when he removed the bandaging, for indication of angiologist. In my opinion, this led to the amputation of both lower limbs.
Keywords: Peripheral Artery Disease; Vascular Leg Ulcers; Compression Therapy
- Michaël Rochoy., et al. “Use of the ankle-brachial index in the detection of peripheral arterial disease of the lower extremities in general medicine”. Annales de Cardiologie et d'Angéiologie (Paris) 70.2 (2021): 75-80.
- O´Donnell TF Jr., et al. “Management of venous leg ulcers: clinical practice guidelines of the Society for Vascular Surgery ® and the American Venous Forum”. Journal of Vascular Surgery 60 (2014): 3S-59S.
- Sánchez Fernández de la Vega C. “Compression to reduce leg oedema in patients with arterial occlusive disease. Double focal compression bandaging”. Veins and Lymphatics 7 (2018): 7980.
- Eberhard Rabe., et al. “Risks and contraindications of medical compression treatment. A critical reappraisal. An international consensus statements”. Phlebology7 (2020): 447-460.
- Adams RH and Alitalo K. “Molecular regulation of angiogenesis and lymph angiogenesis”. Nature Reviews Molecular Cell Biology 8 (2007): 464-478.
- I Buschmann and W Schaper. “Arteriogenesis versus angiogénesis: Two mechanisms of vessel growth”. News Physiology Science 14 (1999).
- Cai WJ., et al. “Remodeling of the adventitia during coronary arteriogenesis”. American Journal of Physiology-Heart and Circulatory Physiology 284 (2003): H31-H40.
- Fung E and Helisch A. “Macrophages in collateral arteriogenesis”. Frontiers in Physiology 3 (2012): 353.
- Brian H Annex and John P Cooke. “New Directions in Therapeutic Angiogenesis and Arteriogenesis in Peripheral Arterial Disease”. Circulation Research 128 (2021): 1944-1957.
- Heill M., et al. “Arteriogenesis versus angiogenesis: similarities and differences”. Journal of Cellular and Molecular Medicine 1 (2006): 45-55.
- Sánchez Fernández de la Vega C. “Double Focal Compression Bandaging Technique: How Long Does a Vascular Ulcer Need to Heal?” Acta Scientific Clinical Case Reports7 (2022): 36-48.
- Sánchez Fernández de la Vega C. “Focalized pressure on the wound bed prevents infection. Double focal compression bandaging”. International Journal of Information and Review 7-10 (2020): 7113-7120.
- Vesely DL., et al. “Three peptides form the atrial natriuretic factor prohormone amino terminus lower blood pressure and produce a diuresis, natriuresis, and/or kaliuresis in humans”. Circulation 90 (1994): 1129-1140.
- Nakao K., et al. “Molecular biology and biochemistry of the natriuretic system. I. Natriuretic peptides”. Journal of Hypertension 10 (1992): 907-912.
- C Sanchez. “Wound debridement. Double focal compression bandaging technique”. International Journal of Information Research and Review1 (2021): 7163-7168.
- Tendera M., et al. “ESC Guidelines on the diagnosis and treatment of peripheral artery diseases: Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries: the Task Force on the Diagnosis and Treatment of Peripheral Artery Diseases of the European Society of Cardiology (ESC)”. European Heart Journal22 (2011): 2851-2906.
- “ACCF/AHA Focused Update of the Guideline for the Management of Patients with Peripheral Artery Disease (Updating the 2005 Guideline”. Journal of the American College of Cardiology 58 (19): 2020-2045.
- Layden J., et al. “Diagnosis and management of lower limb peripheral arterial disease: summary of NICE guidance”. BMJ: British Medical Journal (2012): 345.
- Norgren L., et al. “Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II)”. European Journal of Vascular and Endovascular Surgery 33 (2007): S1-75.
- Eberhard Rabe., et al. “Risks and contraindications for medical compression treatment”. Phlebolymphology1 (2021): 1-36.
- Mosti, G., et al. “Compression therapy in mixed ulcers increases venous output and arterial perfusion”. Journal of Vascular and Surgery 1 (2012): 122-128.
- C Sánchez and H Partsch. “Healing of an arterial leg ulcer by compression bandaging: a case report”. Journal of Wound Care (2017).