Many vascular technologists today continue to perform augmentations manually during venous reflux tests. Often times, they encounter tedious little inconveniences that make these tests drag on and on: twisting and turning, slipping off the vein, etc. No wonder technologists dread these exams!
Leah Jolly, BS, RVT and her team at Mint Medical Education were no exception. However, Leah and her colleagues recently gave the VenaPulse Hands-Free Augmentation Device a try and they cannot wait to get one for their facility! The following is an email from Leah to ACI Medical’s VenaPulse device specialist:
Happy New Year to you too!
My co-workers and I really enjoyed working with your device. We have been doing augmentations manually for years… what a treat to have a break from all the twisting and turning! It also seemed to shorten our exam times a bit, which was a nice bonus.
The foot cuff was VERY helpful when assessing the lower leg. I did have some difficulty adjusting it properly on patients with small feet. Otherwise, it made some of the more tedious parts of the exam fly by, knowing that we were able to get a good augmentation without slipping off the vein.
We loved the foot pedal control too – so much easier than a remote.
Our plan is to convice the boss to purchase a VenaPulse for us… Hopefully soon!
Do you think your facility could benefit from the VenaPulse device for venous reflux tests? You can give it a try for free today! ACI Medical even pays shipping. Call (888) 453-4356 or email firstname.lastname@example.org for your free trial.
According to a new review in the Journal of Vascular Surgery, Intermittent Pneumatic Compression therapy to treat peripheral artery disease has so far seen promising results. However, Sheldon et al. believe there is much more to be explored if IPC device makers intend to optimize their machines for PAD.
This new review highlights the need for researchers to identify what physiological and molecular mechanisms are responsible for successful IPC therapy. Although the improvement of vascular circulation is an important factor in determining whether or not an arterial IPC device is effective, the authors of this review suggest that improving responses on a deeper level would bring IPC therapy to new heights.
Read the abstract here or download the PDF:
New Insights into the Physiologic Basis for Intermittent Pneumatic Limb Compression as a Therapeutic Strategy for Peripheral Artery Disease
Ryan D. Sheldon, MS, Bruno T. Roseguini, PhD, M. Harold Laughlin, PhD, and Sean C. Newcomer, PhD. Columbia, Mo; São Paulo, Brazil; and San Marcos, Calif. Journal of Vascular Surgery 2013; 58:1688-96.
The capability for externally applied rhythmic limb compressions to improve the outcomes of patients with peripheral artery disease has been recognized for nearly a century. Modern technology has permitted the development of portable and cost-effective intermittent pneumatic compression (IPC) systems to be made readily available for affordable at-home use. Mounting clinical evidence attests to the effectiveness of this strategy, with improvements in claudication distance rivaling those seen with exercise training or pharmacologic interventions, or both. However, owing to a lack of mechanistic knowledge, whether current application protocols are optimized for clinical outcomes is unknown. Traditional thinking has suggested that IPC transiently elevates blood flow, which is purported to relieve ischemia, improve vascular function, and promote vascular remodeling. Surprisingly, much ambiguity exists regarding the physiologic stimuli and adaptations that are responsible for the clinical effectiveness of IPC treatment. This review presents and critically discusses emerging evidence that sheds new light on the physiologic and molecular responses to IPC therapy. These novel findings highlight the importance of characterizing the phasic changes in the hemodynamic profile during IPC application. Further, these studies indicate that factors other than the elevation in blood flow during this therapy should be taken into account when designing an optimal IPC device. Lastly, we advance the hypothesis that manipulation of IPC stimulation characteristics could potentially magnify the documented clinical benefits associated with this therapy. In conclusion, recent evidence challenges the physiologic basis on which current IPC systems were designed, and further research to elucidate the basic and clinical outcomes of alternate stimulation characteristics is necessary.
This marks the second year that ArtAssist®…The Arterial Assist Device® was discussed at VEITHsymposium.
This presentation from Professor Andrew N. Nicolaides reviewed the medical implications of ArtAssist® device therapy, as well as some of the clinical trials that were performed on patients with critical limb ischemia (CLI).
“The ArtAssist device takes advantage of the high venous pressure in the veins in the sitting position. It provides rapid compression of the foot and then the calf to 120 mmHg for three seconds. The rapid compression ensures that maximum pressure is reached within 300 ms. This is repeated three times every minute. This intermittent pneumatic compression empties the veins and in the presence of competent venous valves the venous pressure at the ankle is reduced to 15 mmHg. There is no effect on the arterial pressure which remains 180 mmHg. As a result dP becomes 180-15=165 mmHg. This increased dP results in increased arterial flow by 114% (1).“
Most notably, Prof. Nicolaides attributes the long-term benefits of ArtAssist® device therapy to the natural phenomenon of arteriogenesis. This means that over time, patients who use the device daily can be subject to the non-invasive remodeling of their vascular tree. Existing collateral vessels are encouraged to grow and provide much needed blood to the extremities.
Desert Foot, the High Risk Diabetic Foot Conference, takes place from November 20-22, 2013 in Phoenix, AZ.
If you are attending, we would love for you to stop by the ACI Medical booth to talk to Dana Lockrey, our National Account Manager.
You can contact him before the meeting at email@example.com regarding treatment with ArtAssist®…The Arterial Assist Device® for the non-invasive treatment of diabetic ulcers and PAD.
Dana has tremendous experience handling VA accounts and working with veterans.
Additionally, don’t forget to listen in on “Programmed Pneumatic Compression: New Advances in Arteriogenesis” on November 20 from 4:20 to 4:40. Groundbreaking research has been done on the effects of pneumatic compression therapy on non-operable patients with severe circulatory disease. To get an idea before the meeting, visit the Arteriogenesis section on our Clinical Studies page.
Click here to view the entire Desert Foot program online.
We hope to see you there!
As you may or may not know, ACI Medical has a small business attitude when it comes to customers and clients. Even though we do distribute the ArtAssist® device through other (exceptional) organizations, we have always been involved in making sure patients are satisfied with their therapy. The ArtAssist® device has so much to offer for non-operable patients, but what really matters is when a support system comes through.
Here is a recent example of how our customer service team works to serve patients (letter is unabridged except for identifying information):
My husband and I want to thank you for the expeditious service in receiving the ACI medical device.
I know that the device has improved his circulation. Due to his chronic health issues, (COPD, diabetic, kidney problems), the vascular surgeon said that my husband will no longer be a candidate for surgery. It is the ACI device that is currently maintaining proper circulation to his legs, feet, & toes.
I am an advocate for this device and have watched his ulcer wounds heal with consistent and proper use of the device.
Per our phone conversation on Monday, October 14, you advised me that I would receive another machine due to the unfortunate malfunction of the one that I originally received. Today, October 15th, Tuesday, at 9:30 AM eastern time, the doorbell rang and on our front steps was the new replacement.
Two words for your service, appreciation and gratitude. You too have now become a major contributor to my husband’s health and well being.
With much appreciation,
Many vascular technologists today use manual augmentations to perform venous reflux exams. Augmentations to the study
patient’s leg are essential to the documentation of valves, but unfortunately, technologists only have two hands to operate the ultrasound machine, hold the wand to the desired location, and perform augmentations. Squeezing the patient’s leg manually can result in difficulties:
To reduce inconsistencies and provide a more comfortable experience for vascular technologists during venous reflux exams, ACI Medical has developed a foot-operated device that performs rapid and consistent augmentations: the VenaPulse® Hands-Free Augmentation Device. The picture on the right features Professor Nicos Labropoulos using the inflation cuff system during a demo at the Venous Symposium earlier this year. His left hand is free to operate the ultrasound. A published prospective study from 2009 compares the VenaPulse® device’s performance with traditional manual augmentations. Conclusion: The VenaPulse® device is just as effective as doing manual augmentations during venous reflux exams.
Prospective comparison of the pneumatic cuff and manual compression methods in diagnosing lower extremity venous reflux
Stavros K. Kakkos, MD, PhD, Judith C. Lin, MD, FACS, Jennifer Sparks, RVT, Melissa Telly, RVT, Michalene McPharlin, RN, RVT, and Daniel J. Reddy, MD, FACS. Vascular and Endovascular Surgery, Vol. 43 No. 5: pp. 480-484. http://ves.sagepub.com
To compare pneumatic cuff with manual compression in diagnosing reflux in patients with chronic venous insufficiency (CVI).
Patients and Methods
Eighteen patients (Clinical Etiologic Anatomic Pathophysiologic [CEAP 2-5], median Venous Clinical Severity Score [VCSS 6.5]) were studied. The VenaPulse device (ACI Medical, San Marcos, California) was used for cuff inflation. The hemodynamic performance of the 2 methods was tested in the first 9 patients, while their diagnostic value was tested in the last 9 patients.
Both methods induced equal compression with median peak velocity of the antegrade flow (PVA) being 86 cm/s (P=.65). Coefficient of variation (CV) for PVA in the superficial veins was significantly higher with the manual method (16.8%) compared to the VenaPulse method (9.5%, P<.001), while sensitivity and specificity were 85% and 100%, and 78% (κ .68, P<.001) and 100%, respectively.
Pneumatic cuff and manual compression were shown to be equally effective in diagnosing venous reflux. Cost-effectiveness and ease-of-use studies comparing these methods are justified. Keywords: vascular lab; varicose veins; pneumatic compression
ACI Medical will be joining VEITHsymposium ™ as an exhibitor this year. VEITHsymposium ™ is one of the largest gatherings of vascular specialists in the US. If you would like to visit the ACI Medical booth at the meeting, we will only be exhibiting for one day.
Tuesday, November 19 in the South Corridor, 2nd Floor
VEITHsymposium ™ is scheduled from Tuesday, November 19 through Saturday, November 23. During this time, vascular specialists from around the world will be giving hundreds of short presentations on the latest advances in vascular medicine.
On Thursday, November 21 at 4:21 PM, Professor Andrew N. Nicolaides is scheduled to present on ArtAssist®…The Arterial Assist Device® and what it can do to medically treat critical limb ischemia.
Use of the ArtAssist® device in the treatment of CLI: How does it work and when should it be used
Professor Nicolaides is one of the foremost experts on the relatively new arterial pump technology. Nicolaides was part of a team that evaluated and optimized the ArtAssist® device to maximize circulation. Since having laid the groundwork for this medical device, the ArtAssist® device has been shown in many clinical trials to facilitate wound healing and limb salvage by effectively doubling and tripling blood flow.
For discussions and questions prior to and after Professor Nicolaides’ presentation, ACI Medical welcomes you to visit our booth. As the pioneers of the most advanced arterial pump technology to date, ACI will be able to go into depth with you about the science and engineering behind the ArtAssist® device.
Who here has heard of compression therapy for poor circulation? What is the first thought that comes to mind?
Many patients are not aware of the full benefits that compression therapy can bring for poor circulation. Many doctors also remain in the dark or are skeptical of this therapy’s effectiveness. Indeed, there are products in the market that are largely untested in a clinical setting. Despite their lack of evidence, they are still marketed to patients as an “effective” solution for poor circulation.
In reality, not all arterial pump brands are the same. It really shows when a pump is not optimized for its intended purpose.
To illustrate, we at ACI Medical have put together a simple chart that combines three limb salvage statistics:
An 80% limb salvage rate is outstanding for bypass surgery. But what if you are in the other 20%?
This chart takes the lowest limb salvage success rate for ArtAssist®…The Arterial Assist Device® and the most impressive rate found for the competitive arterial pump. Which compression therapy brand would you choose if bypass surgery was not an option?
(Charts are approximately to scale. Click to enlarge.)
As a pioneering technology, ArtAssist®…The Arterial Assist Device® faces resistance in the medical community at large. In this case, Ireland’s Health Information and Quality Authority (HIQA) cites the “lack of high quality, reliable evidence to support the widespread adoption of this technology” in its Health Technology Assessment (HTA).
The ArtAssist® device has been clinically shown to drastically improve circulation in patients with limb-threatening ischemia, a result of advanced peripheral arterial disease (PAD). Many doctors, including Mr. Sultan at the Galway Clinic, prescribe ArtAssist® device therapy to patients who are not candidates for surgical intervention.
Understandably, doctors responsible for the well-being of their patients may be skeptical of new technologies such as IPC to treat PAD. The fact remains, however, that the only “widespread” course of action after failed attempts at revascularization is amputation of the limb. Since PAD often affects the aged population, the aftermath of amputation can be extremely detrimental to a patient’s quality of life in addition to being a financial burden on the state.
Mr. Sultan, in response to the HTA report:
“The question is, is it a safe procedure, does it save limbs, does it decrease pain and does it control ulcers? The answer in all these cases is yes.”
Mr. Sultan continues to say that he has saved over 500 limbs with this IPC technology over the past eight years, which would have otherwise been scheduled for amputation. Furthermore, numerous studies on this device have been published in Vascular and Endovascular Surgery, a peer reviewed medical journal. The cost of renting the machine for three months is comparable to one night in a hospital bed.
To read the article in full, please visit: http://www.imt.ie/news/latest-news/2013/07/hta-on-ipc-is-challenged-by-surgeon.html?doing_wp_cron