The use of transcutaneous electrical stimulation of the calf undergoing infra-inguinal bypass surgery.

Abstract

1.1. Objective Infrainguinal bypass surgery is frequently associated with significant post reperfusion oedema of the limb. This may lead to surgical wound complications as well as limit the patient's early postoperative mobility. We conducted a prospective randomised controlled trial to evaluate whether the application of electrical calf muscle stimulation in the first postoperative week after infrainguinal bypass surgery reduces lower limb swelling of reperfusion oedema and improves venous and arterial flows at one and six weeks post-operatively. 1.2. Methods Forty consecutive patients over a one-year period who were due to undergo infrainguinal bypass for critical lower limb ischaemia were recruited and randomly divided into the control, who received the current standard of care, and study group, who received electrical calf muscle stimulation for a one-hour session twice daily for the first post-operative week via the use of a standard CE marked device. Pre-operatively, at one-week post-operatively and again at six weeks post-operatively, the limb was measured using a tape measure at three predetermined sites and an arterial and venous ultrasound scan performed with measurement of peak systolic velocities and flow volumes measured. 1.3. Results The control and study groups were well matched for age, side and type of surgery, and all tested risk factors and relevant treatment (all P > .05). The mean age was 72.75 years and 70.95 years in the control and study group respectively. In both groups, the predominant surgical procedure was a femoral to below knee popliteal bypass using ipsilateral long saphenous vein. At one week, the below-knee girth and calf girth were significantly less in the study group (P = .025 and P = .043 respectively). Venous flow volume at rest and venous flow volume on stimulation were significantly more in the study group (P = .01 and P = .029 respectively). At six weeks, the below knee girth remained significantly less in the study group (P = .011).