Perspectives in Circulation Today

NO! NO! NO! All Boots Are Not Created Equal!

Do you know the differences? Have you any experience with boots designed to assist the circulation?

The Heart and the Circulator Boot:

The Big Toe and the Circulator Boot

The Heart: Other pneumatic compression devices employed to assist the heart are not really boots but two or more cuffs placed around the calf, thigh and buttocks. The presence of a rigid structure around the leg gives the Circulator Boot system definite physical and physiologic advantages (Vascular Physiology Often Ignored. A Vector Analysis of Leg Forces in Pneumatic Compression Treatments - Boyle's Law). The first graph above was taken from hemodynamic data published in Angiology (Circulator Boot vs ECP. It is seen that Long Boot therapy significantly and rapidly augments cardiac output and stroke volume. The benefit is most prominent when both legs are treated after every heartbeat but is still significant when one leg is treated after every heart beat or both legs treated after alternate heartbeats. Of importance is the fact that stroke volume and cardiac output dropped when the boot was programmed to compress the legs during systole in spite of the fact Starling's Law might have predicted they would increase because of increased venous and lymphatic return. Again of importance is the fact that pumping on the "clock" mode independent of the heart cycle resulted in decreases in stroke volume and cardiac output. Inappropriately timed leg compressions both increase cardiac afterload and impede arterial flow into the legs. The FDA early recognized the cardiac-assist potential of the Circulator Boot and approved its usage in congestive failure. Among our case histories on our website are patients who have been successfully treated in the outpatient clinic, the emergency room, the intensive care unit and the general floor hospital room for an acute myocardial infarctions, congestive heart failure and septic shock. Our cardiologist tolerated our successes but did not interest themselves in the technology. Nor has the cardiology societies or insurance companies presumably preferring more invasive and more highly reimbursed procedures. In the past large corporations have overcome such hurdles by paying physicians to do appropriate studies. Such largess is viewed with suspicion today.

The Leg and the Foot The patient studied in the above graph had asked her physician about boot therapy. He said he could get a boot and treat her and, indeed, tried to do so with a slow-acting boot that produced pain. Here we tried to discover what the cause of the pain was. A fine platinum electrode was inserted in her foot and her subcutaneous PO2 levels were measured by the polarographic method. A Circulator Boot on a manual mode was inflated and deflated at about ten second interval to mimic the action of her doctor's boot. The oxygen tension fell and pain was produced. The Circulator Boot monitor was then set to end-diastolic mode and the oxygen tension rose rising eventually off the record. Compression techniques do make a difference! Physicians may do well to remind their technicians that there is an important clinical difference between setting a long boot to pump a leg for 0.42 seconds 75 times a minute on a manual setting and setting the boot to pump in end-diastole for 0.42 seconds in a normal patient with a pulse rate close to 75 beats per minute; on the manual setting, the subject (perhaps the technician) may get numb feet after several minutes which can be reversed in the end-diastolic setting.
Why a "Manual Setting"? The manual setting allows the boot technician to mimic the action of most other boots. Thus, the Circulator Boot, for example, can be programmed to compress the leg automatically for one second every ten seconds (6 times a minute). Or by manually turning compressions off and on (clock mode, delay 0.01 seconds and compression 0.99 seconds), the technician can compress the leg for any desired intervals. Such usages of the equipment are not recommended by the Circulator Boot Corporation. Leg compresions return both venous and lymphatic fluid volumes to the heart. Such volumes in the cardiac patient may promote heart failure. Again, leg compressions during systole increase afterload promoting heart failure. In contrast, end-diastolic pumping increases cardiac output and the production of urine. Why then have a manual mode? Some patients with rapid atrial fibrillation are difficult to treat even pumping after every 2nd or 3rd heartbeat. Then, there is the patient with iliac occlusions in whom boot-induced alterations in femoral artery pulsations are not readily transmitted back to the heart. Such patients can still benefit from boot therapy (Case27: Holding the Line in Patient with Severe Iliac Disease)
The Circulator Boot Corporation denies responsibility for adverse cardiac and leg events when technicians do not adhere to the operating instructions in our publications and manuals.

Unique Features of Circulator Boot Systems for the Wound-Healing Clinic

Factor

Cardiac-assist allows treatment of patients too sick to undergo other therapies.

Adjustable elements of equipment allows treatment of a desired portion of leg in most all people.

Inclusion of fluids within the boot allows effective debridements.

Concomitant usage of local antibiotic injections into the tissues and/or soak fluids allows successful treatments of difficult infections.

Potential usage in many sites: office, clinic, emergency room, intensive care unit, nursing home or ship-at-sea.