Compression dangerous with arterial insufficiency

Can result in ischemic necrosis

Most patients with venous hypertension and venous ulcers are suitable candidates for compression therapy. But using compression on the wrong patients - those with arterial disease - can be calamitous. Experienced clinicians emphasize repeatedly that if a patient has inadequate arterial blood supply in the legs, external compression can lead to ischemic necrosis.

"I cannot stress enough that it is critical, any time you consider compression bandaging, to assess the patient's arterial circulation," says Tamara Fishman, DPM, president of the Wound Care Institute in North Miami Beach, FL. "This is often forgotten. You have to rule out arterial insufficiency before you put on any compression bandage; otherwise, the bandage can act as a tourniquet."

Fishman also emphasizes the need to medically manage any patient with edema and not just "slap on compression." Understanding the etiology of the wound is crucial because not all leg edema and ulcers are the result of venous disease. Patients should be assessed for underlying conditions and systemic disorders such as heart disease, diabetes mellitus, cellulitis, hepatic disease, and renal problems that can also result in swelling, but may not respond to compression therapy.

But the presence of arterial insufficiency is the greatest danger. One author stated it clearly: "If compression is applied to an ischemic limb, further reduction in blood flow occurs and this may result in pressure necrosis, sometimes requiring amputation."1

One common way to assess the patient's arterial status before beginning compression therapy is via an ankle brachial index (ABI). This is done by taking the systolic blood pressure at the ankle and dividing it by the systolic blood pressure at the brachial artery, experts tell Wound Care. An adequate arterial supply will show up as ratio of close to one or above, because blood pressure at the ankle should be greater than at the arm. An ABI of less than 0.6 is a signal that the patient may not be suitable for compression therapy.

Reference

1. Moffatt CJ, Dickson D. The Charing Cross high compression four-layer bandage system. J Wound Care 1993; 2:91-94.