Deep Venous Thrombosis (DVT) in Trauma: a Literature Review

A-V Foot Pumps

First Author	Year	Reference Title	Class	Conclusions
Gardner AMN	1983	The venous pump of the human foot-- preliminary report. Bristol Medico-Chirurgical J 98:109-12	III	First description of the physiologic pumping mechanism on the sole of the foot.
Laverick MD	1990	A comparison of the effects of electrical calf muscle stimulation and the venous foot pump on venous blood flow in the lower leg. Phlebography 5:285-90	III	This study demonstrated that A-V foot pump increases venous blood flow in popliteal vein by 250%.
Bradley JC	1993	The effectiveness of intermittent plantar venous compression in prevention of deep venous thrombosis after total hip arthroplasty: A randomized prospective trial. J Arthroplasty 8:57-61	II	74 patients undergoing total hip replacement compared SQ heparin to A-V foot pumps. SQ heparin - 27% DVT vs A-V foot pump - 6.6% DVT.
Stranks GJ	1992	The A-V Impulse System reduces deep-vein thrombosis and swelling after hemiarthroplasty for hip fracture. J Bone Joint Surg 74B:775-78	II	Prospective randomized trial of TED stockings ± A-V foot pumps. Control group had 23% DVT rate vs 0% in the A-V foot pump group.
Fordyce MJ	1992	A venous foot pump reduces thrombosis after total hip replacement. J Bone Joint Surg 74B:45-9	II	Randomized, controlled study of 84 patients with TED vs TED & A-V foot pump. Venography follow-up revealed 10% DVT rate in A-V foot pumped group and 40% in controls.
Wilson NV	1992	Thrombo-embolic prophylaxis in total knee replacement. Evaluation of the A-V impulse system. J Bone Joint Surg 74B:50-2	II	Prospective trial of 59 patients with no prophylaxis vs A-V foot pumps. Control DVT rate was 68.7% and A-V foot pump was 50% detected by venography, with major DVT in 59% vs 18%, respectively.

A-V Foot Pumps

First Author	Year	Reference Title	Class	Conclusions
Gardner AM	1990	Reduction of post-traumatic swelling and compartment pressure by impulse compression of the foot. J Bone Joint Surg 72B:810-5	III	Multicenter trial showed decrease in pain and compartment pressures with the use of A-V foot pumps. Hypothesized that this was due to release of endothelial-derived relaxing factor in microcirculation.
Morgan RH	1991	Arterial flow enhanced by impulse compression. Vasc Surg 25:8-15	III	22 patients with peripheral vascular disease had relief of ischemic rest pain with use of A-V foot pump.
Abu-Own A	1993	Effects of intermittent pneumatic compression of the foot on the microcirculatory function in arterial disease. Eur J Vasc Surg 7:488-92	III	A-V foot pumps increased transcutaneous oxygen and laser Doppler fluxemetry in patients with severe claudication.
Knudson MM	1996	The use of low molecular weight heparin in preventing thromboembolism in trauma patients. J Trauma 41:446-59	II	A-V foot pumps used as one limb of prospective study on DVT prophylaxis. Foot pumps had a higher DVT rate (not significant) than LMWH or SCD, and there were complications with their use.
Westrich GH	1996	Prophylaxis against deep venous thrombosis after total knee arthroplasty. Pneumatic plantar compression and aspirin compared with aspirin alone. J Bone Joint Surg 78A:826-33	I	122 patients (164 knees) compared DVT with A-V foot pumps and aspirin (27%) vs aspirin alone (59%; p<0.001). No proximal DVT occurred with A-V foot pumps vs 14% with aspirin (p<0.0003). Length of time foot pump was used significant for development of DVT. Patients with no DVT wore foot pump for 96±23.4 hours. Patients with DVT wore foot pump for 67±21.1 hours (p<0.001).
Santori FS	1994	Prophylaxis against deep-vein thrombosis in total hip replacement. Comparison of heparin and foot impulse pump. J Bone Joint Surg 76B:579-83	I	132 patients randomized to receive subcutaneous heparin vs A-V foot pump with 35.4% vs 13.4% incidence of DVT (p<0.005). There was one fatal PE and nine patients (13.8%) with excessive bleeding in the heparin group vs none in the A-V foot pump group.