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Endothelial Activation is Central to Collateral Artery Growth in PAD Patients

Collateral artery growth is possible for patients with critical limb ischemia with the use of external pneumatic compression therapy. Many vascular specialists are skeptical of this notion because it sounds contradictory:  how can a completely non-invasive treatment improve microvascular circulation to the point that the limb is saved?

Efficacy lies in the activation of the endothelium by way of exerting shear stress on the vessel.

Vascular specialists have good reason to be wary of most compression pumps claiming to promote better circulation and limb salvage. This is because the developers of such pumps did not design their systems with the endothelium in mind, preferring instead to modify lymphedema pumps or DVT prophylaxes to exert more pressure on the patient’s limb at slow compression and decompression rates (two or more seconds). Little clinical evidence exists to support this technique and little thought was put into this type of system’s design for arterial disease treatment. Furthermore, with such compression pumps, little or no pressure is applied to the foot or watershed areas, limiting cutaneous blood flow in these regions.

Now, for the endothelium. When shear stress is exerted on a vessel, its inner lining naturally secretes vasodilators and anticoagulants such as nitric oxide and TcPO2. In effect, the vessel temporarily widens, allowing more inflow. This effect can only be achieved with rapid external compression and decompression (each less than 0.5 seconds). Over time, the daily application of shear stress will encourage the growth of existing collateral arteries, as seen below:

angiogram van bemmelen artassist arterial pump technology

Arteriogenesis (or collateralization/collateral artery growth) explains why patients have long-term results after stopping ArtAssist® device usage

The ArtAssist® device is the only external pneumatic compression pump designed to focus on collateral artery growth. It activates the endothelium with rapid compression and decompression rates in the foot, ankle, and calf regions. This addresses poor circulation and wounds present from heel to toe, as well as in the rest of the limb.

Acquiring an ArtAssist® device is simple and may be reimbursed by insurance in certain areas of the United States. Device technology experts can discuss medical benefits with both physicians and patients, and will also fulfill orders. Call or email ACI Medical to begin:  toll free (888) 453-4356 or info@acimedical.com.

ArtAssist Device collateral artery growth

The ArtAssist® device is available in the US and internationally.

 

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Peripheral Arterial Disease won’t wait ’til next September – keep your education going!

Just because PAD Awareness Month is over doesn’t mean the disease won’t persist. I’m glad there’s a month dedicated to PAD education – this means that from now on, you can carry on everything you learned and share this invaluable knowledge with those around you. Last month was also a reminder to me what an important role prevention plays; that diseases like PAD won’t stop to let their victims try to figure out what’s going on.

On that note, I’d like to thank all those on Twitter who have participated with the effort by sharing their expertise and their resources, as well as including my two cents on the big conversation. I learned a lot!

If September was not enough to get your fill of PAD education, take a look through our dedicated category, where you’ll find articles written by yours truly in regards to the ArtAssist® Arterial Assist Device® and links to various experts who deal with the many complications of PAD.

Have a great day and STAY INFORMED!

All the best,

Diana

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Using a Pneumatic Compression Device for Lower and Upper Extremity Peripheral Arterial Disease | FAIM.org

ArtAssist pneumatic compression device

ArtAssist®…The Arterial Assist Device®

by Steven Kavros, DPM

Intermittent pneumatic compression (IPC) of the lower limb is a well-documented method of arterial leg inflow enhancement in patients with peripheral arterial disease (PAD). The mechanism of action parallels the natural muscular contraction of the leg stimulating blood flow. There are three very short compression cycle per minute inflating a cuff encompassing the legs and or feet simulating the beneficial effects of walking. The rapid rise of the cuff pressure assists with emptying of the venous blood of the extremities and allows oxygenated blood to move down the limb delivering nutrients to deprived tissues. This simple mechanism of action also allows edema or swelling of the extremity to be relieved. By relieving swelling, additional oxygenated blood can be delivered to the ischemic limb. Additionally, there is an increase release of nitric oxide and certain tissue and platelet derived growth factors. The nitric oxide has a positive effect on the internal cells that line the vessel wall, enabling relaxation and improved flow. Other tissue and growth factors lead to the development of new blood vessels and therefore, improve the delivery of additional oxygen and nutrients to the extremity.

Read the rest via Using a Pneumatic Compression Device for Lower and Upper Extremity Peripheral Arterial Disease | Foundation for Alternative and Integrative Medicine.

Since the Internet is all about getting info quickly and moving on, here’s what this medical jargon means in plain English…

Dr. Kavros is talking about a leg pump (what we’ll refer to as an arterial pump) that is proven to improve circulation to the legs and feet when the arteries are blocked. When your arteries are significantly blocked, your muscles start sending pain signals to your brain. This is called PAD –  think of it as a heart attack of the legs.

The way this arterial pump technology works is by simulating walking for your blood-deprived muscles. Instead of making you get up and walk, this therapy happens while you’re sitting in a chair. When you walk, blood in the veins travels up to your heart, gets refreshed and loaded with oxygen/nutrients, and then comes back down to feed the starving muscles. The better circulation you have in your legs, the less they will hurt.

Dr. Kavros says that this compression sequence can also reduce swelling. This pump compresses your leg three times per minute. If you use the pump for three hours a day, imagine how much more blood flow you’re getting!

A fringe benefit to this therapy that was recently discovered is your body’s natural release of nitric oxide. This substance is not to be confused with nitrous oxide, which is what your dentist will give you to make you laugh at his dumb jokes while he’s working on your teeth. When nitric oxide is released by the lining of your arteries, your blood vessels temporarily open up to accept more nutritious blood. Again, this happens three times a minute so that your blood vessels are constantly widened throughout therapy.

This is the compression technology Dr. Kavros is talking about:  The ArtAssist® device. To learn more, click the picture!

Update:  Dr. Paul van Bemmelen has also written an article for faim.org about pneumatic compression device therapy for PAD. Read it here

ArtAssist pneumatic compression device

ArtAssist®…The Arterial Assist Device®

 

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Hope in the Face of Amputation: Mary Tells Her Mother’s ArtAssist® Device Story

Diana’s note:  I’ve been digging around on the server lately for material I could use to add to this website. I came across two wonderful stories of patients whose lives were regained because they underwent ArtAssist® Device therapy. These people wished for their testimonials to be shared with others with the hope that anyone suffering from severe PAD would know that there’s one more hope before amputation.

Mary’s mother had run out of options and was on her way toward amputation when doctors suggested the ArtAssist® Device. Here is Mary’s letter to ACI Medical on behalf of her mother (identifying information has been omitted, but it is otherwise unabridged):

November 7, 2006
ACI Medical
1857 Diamond Street
San Marcos, CA 92078-5129

To Whom It May Concern:

A little over three months ago, my mother was an active and independent 83 year-old woman, who lived alone, drove a car and took walks around the block. She began to have a very cold foot, trouble walking and developed pain and ulcers on her left foot and ankle. (She experienced pain just putting a sock on her left foot). She became unable to take her walks, in fact, she would call us because she also experienced intermittent extreme pain and could not move from one room to the next without assistance.

She was diagnosed with peripheral vascular occlusive disease. Several tests and visits to specialists indicated my mother was not a candidate for bypass surgery. Amputation was discussed, which would have been necessary if she developed gangrene. In an effort to avoid amputation, the doctors suggested she take the prescriptions Plavex and Pletal and use the ARTERIAL ASSIST DEVICE.

My mother used the ARTERIAL ASSIST DEVICE along with the Plavex and Pletal for a three-month period. I am happy to report to you that my mother is again an active and independent 83 year-old woman who is taking walks around the block! Thank you to the inventors of the ARTERIAL ASSIST DEVICE!

I am writing this letter so that someone out there who may be as severe as my mother was would ask their doctor about trying this device in an effort to avoid amputation or surgery. Sometimes there is hope when you think hope doesn’t exist.

Sincerely,
Mary H., Southgate, MI

Next week, you’ll read about a patient whose left leg has been saved not once, but twice thanks to ArtAssist® Arterial Pump Technology!

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Research at the Imperial College of London suggests IPC therapy helps keep arterial bypass grafts in shape

artassist compression sequence device

ArtAssist®…The Arterial Assist Device®

Research carried out at the Imperial College in London shows that an intermittent pneumatic compression (IPC) therapy regimen applied to lower limbs with peripheral arterial disease (PAD) can extend the life and efficacity of infrainguinal arterial bypass grafts. Starting with the knowledge that IPC already dramatically enhances blood flow to the lower extremities, researchers in London tested their hypotheses on patients who had already undergone successful bypass surgery in hopes that IPC therapy would improve the performance of the new vascular system. They were not disappointed.

“IPC was effective in improving infrainguinal graft flow velocity, probably by reducing peripheral resistance,” states the last line of one abstract of a study led by Konstantinos Delis, MD, PhD. “IPC has the potential to reduce the risk of bypass graft thrombosis.”

Many patients with ischemic limbs choose to have a bypass procedure done to restore arterial blood flow to their lower extremities. Though bypass procedures are often a reliable treatment solution for limb ischemia, the newly-revascularized limb is still susceptible to returning to its atherosclerotic state if regular blood flow is not maintained.

To prevent return of this disease’s symptoms, some patients are able to exercise regularly. Others, however, remain in danger of being revisited by PAD’s painful consequences.

This is where IPC therapy comes in:  by sequentially compressing the foot, ankle and calf, IPC mimics the physiological benefits of taking a brisk walk. Both walking and IPC activate the calf muscle pump, which pushes venous blood back towards the heart to be re-oxygenated and sent back to the legs at a greater velocity. This increase in blood flow effectively increases chances of recovery from the effects of PAD.

In one study, researchers at the Imperial College of London applied an IPC device to patients who had already successfully undergone an arterial bypass graft (femoropopliteal & femorodistal). Five outcome measures, including volume flow in the grafts, yielded encouraging results directly after IPC therapy. Blood flow had improved significantly in all areas for both types of bypass grafts.

Having one more option for maintaining healthy blood flow to the lower limbs could dramatically change a PAD patient’s quality of life by decreasing the number of surgical procedures and time spent in the hospital.

The IPC device used in this clinical study was the ArtAssist® Arterial Pump developed by ACI Medical, LLC.

Reference:

Haemodynamic Effect of Intermittent Pneumatic Compression of the Leg After Infainguinal Arterial Bypass Grafting. Delis, K. et al. St. Mary’s Hospital, Imperial College School of Medicine, London, UK. Br J Surg 2004; 91: 429-34

Other studies of interest:

Enhancing Foot Skin Blood Flow in Patients with Infrainguinal Arterial Bypass Grafting Using Intermittent Pneumatic Compression. Husmann, M.J.W.; Delis, K.T.; Lennox, A.F.; Nicolaides, A.N.; Standsby, G. Irvine Laboratory for Cardiovascular Research, St. Mary’s Hospital, London, UK. 21st Conference in Microcirculation, June 2000

Effects of Intermittent Pneumatic Compression of the Calf and Thigh on Arterial Calf Inflow: A Study of Normals, Claudicants, and Grafted Arteriopaths. Delis, K.T.; Husmann, J.W.; Cheshire, N.J.; and Nicolaides, A.N. Imperial College School of Medicine, St. Mary’s Hospital, London, UK. Surgery, 2000, Vol. 129, No. 2, p. 188-195

Enhancing Foot Skin Blood Flux in Peripheral Vascular Disease Using Intermittent Pneumatic Compression: Controlled Study on Claudicants and Grafted Arteriopaths. Delis, K.T.; Husmann, M.J.W.; Nicolaides, A.N.; Wolfe. J.H., and Cheshire, N.J., Imperial College School Of Medicine, St. Mary’s Hospital, London, UK. World Journal Surgery, 2002 Jul;26(7):861-6

Andrew N. Nicolaides on IPC’s potential to enhance endovascular procedures (video)

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Arterial Pump Choosing Guide

At ACI Medical, we know that there are more home-use intermittent pneumatic compression devices (in other words, arterialArtAssist device patient pumps) similar to the ArtAssist® device out on the market, but here is the best we can say for them:  they may work, they may not. This is because the ArtAssist® device is the only device of its kind to have been optimized to treat arterial disease through clinical trials at multiple independent centers. In other words, research done on the ArtAssist® device itself supports our claims about its capabilities.

Through numerous clinical trials, ACI Medical’s researchers have determined what the ArtAssist® device system needs to increase blood flow to the lower extremities as much as it does. If you’re thinking about getting an arterial pump to treat PAD (peripheral arterial disease), here’s what you should look for and why:

Cuff Specifications

Bladder Locations

artassist arterial pump cuff

It is important to have air bladders compressing the foot, ankle and calf regions because this promotes more blood flow to the skin.

When you are considering an arterial pump, also take a look at the size of the air bladders. The larger they are, the more tissue they’re

going to reach. The more tissue they reach, the more circulation.

Inflation and Deflation Rates

Research shows that quick inflation and deflation rates of the air bladders (less than half a second) put what’s called shear stress on your blood cells. Shear stress is good, because when your endothelial cells experience it, they release a muscle relaxant (or a vasodilator called nitric oxide) that helps open the small collateral arteries that are capable of naturally bypassing the blocked artery. It takes around 3 months, and the improvements are long-term. We call this process arteriogenesis or collateralization

Now, this process I described does take a lot longer (typically between 3-6 months) than an open bypass operation, but for people who aren’t good candidates for surgery, it may be worth it to look into arterial pump treatment.

Cuff Pressure

ArtAssist compression sequence 120mmhg

Rapid sequential compression

Now you know that cuffs should have large bladders at the foot, ankle and calf and that they should inflate and deflate quickly. But what kind of pressure should the air bladders reach?

The answer that researchers found was 120 millimeters of Mercury (mmHg), which is about the pressure of a very firm handshake. Below this pressure, blood flow was not as high. Above 120 mmHg was unnecessary and, furthermore, uncomfortable for patients.

Clinical Research

You know I’ve been hinting at it, and I can’t stress it enough:  make sure the device you invest in has clinical research supporting its claims. Research done at respected institutions is usually a very good sign for an arterial pump you’re considering. Also, if you can find a study that’s been done on patients with your diagnosis, even better!

UPDATE:

Being optimized to treat arterial disease is of the utmost importance. Research at the Mayo Clinic suggested that if a pump is NOT optimized for arterial disease, using it could actually DECREASE blood flow – a waste of your precious time and money! For example, some arterial pumps on the market have been modified from DVT prophylaxes and do not have much published clinical support.

So, like any decision you make concerning your health, I encourage you to do a bit of research and ask yourself:  did the makers of this arterial pump design it specifically to treat arterial disease? Straight answers are the best.

Customer Service

Patient Compliance

Basically, make sure you can commit to using your arterial pump for however often your physician has prescribed it. As an example, we’ve seen the ArtAssist® device do amazing things for people – and it’s because they got into the habit of using it every day.

Patient Accommodation

Are you dealing with a special condition? Have you already had a below-knee amputation or are you unable to tolerate foot compression? Is your situation unique? It’s helpful to know that your arterial pump provider is knowledgeable enough to listen to what you’re going through and find a solution so you can get the therapy you need.

Obtaining Your Therapy

Just consider:  how many numbers do you have to call to get an arterial pump? Do you have to go to a clinic every day or can you conveniently keep it at home? Find an arterial pump provider that makes it as easy as possible.

The Arterial Pump That Comes Out On Top

artassist device arterial pump technologyThere’s only one number to call if you want to order, prescribe, or just get more information about the ArtAssist® device:  (888) 4 LEG FLO (888-453-4356). Alternatively, you can email info@acimedical.com any time of the day.

For our references, see our Clinical Studies page.

To read documented success stories of ArtAssist® device patients, take a look through the Case Reports page.

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ArtAssist® Arterial Pump Technology

Home-use compression device for patients with

Peripheral Arterial Disease

The ArtAssist Arterial Pump Device

The reason we named it “ArtAssist®” is because this specially engineered pump and cuff system gives patients’ limbs exactly what they need to heal:  more arterial blood flow. The ideal candidate for this uniquely optimized, completely non-invasive therapy suffers from severe symptoms of peripheral arterial disease – arterial occlusive disease of the upper and lower extremities. In a mere matter of weeks, patients see dramatic improvements, such as lessening of pain and wounds that finally begin to heal as a result of the improved circulation that ArtAssist®…the Arterial Assist Device® promotes. In as little as 90 days, daily usage of the ArtAssist® device can result in permanent improvements to the treated limb’s arterial circulation.

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Patients should be proactive and aware about their PAD

Today, a man came in to our office to talk to us about renting an ArtAssist® device. He has had peripheral arterial disease for years and previously rented our device a few years back.

He came in because, as he said, wound care in other places wasn’t very well agreed upon, and he saw hair regrowth on his feet when he rented and used our device a few years back. His other options were too costly for him, including hyperbaric oxygen therapy (I found a link – click here – to get a ballpark idea of how much each HBO session is).

Today, we wish that more patients were like him because he has lately noticed hair loss on his feet again and is taking steps to prevent his PAD from advancing.

Visit the ArtAssist® device website to see if you or someone you know can benefit from therapy. You can also poke around on the clinical studies page to read what researchers have to say about the device (in a nutshell, it’s efficacious and cost-effective, but don’t feel like you have to take my word for it).

Also, check out all the posts I have on amputation – it would take quite a while to post them all here, but I do have a lot of articles on cost comparison and quality of life.

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