Intermittent vacuum therapy

Intermittent vacuum therapy
SpecialtyCardiovascular

The intermittent vacuum therapy (IVT) is a treatment conducted in case of venous and arterial issues as well as in rehabilitation (after sports injuries[1] and vascular complaints). With the aid of normal and low pressure, it should enable to control venous reflux, enhance lymphatic flow[2] and improve blood flow in periphery and muscles.

Technology

The IVT treatment device consists of a cylindrical space in which the lower body of a lying patient (up until the ribs) is enclosed and affected. The legs are fully comprised. In the waist region, the inner space of the device is sealed by means of a lens. Within the cubicle, a vacuum pump alternatingly generates intermittent normal and low pressure (-20 until -70 mbar). The devices are declared medical devices (Class IIa. CE 0123).

Mode of operation

Through the generation of low pressure, blood circulation within the lower body parts and the abdomen is encouraged, meaning that arterial perfusion is stimulated.[3] This blood flow leads to a reduction of hypertension within the central line, stroke volume, cardiac output and eventually to a reduction of the arterial blood flow which is counteracted through the compensation mechanisms.[4] As a reaction to this change, pulse and peripheral vascular resistance are enhanced. In addition, shearforces are effective[5] and the sympathetic answer of the heart is activated. Blood volume is adapted to the change of pressure within the lower part of the body.[6] The flow of oxygenized blood within the legs and lower extremities is encouraged and enhanced through the changed conditions of normal and low pressure. During the phase of normal pressure, the backflow of venous blood and lymph within the large vessels is facilitated. Through that, the IVT has a strong physiological effect on the “removal of lymphatic waste products”,[7] in other words a lymphatic drainage takes place. The related raise in pH value often entails a strengthening of the connective tissue, leading to an increase of collagen synthesis as well as to improved fat reduction.[8]

The treatment was developed on basis of the LBNPD-method of the NASA[9] (lower body negative pressure device). In 1999, the development of the intermittent variant of the LBNPD started as a neurolab research project at the institute of aerospace medicine of the German Aerospace Centre (DLR) in Cologne.

Physiological mechanism

Intermittent vacuum therapy influences the hemodynamics of the lower extremities through periodic changes in external pressure. The alternation between negative pressure and normal pressure leads to rhythmic changes in vessel diameter and to alterations in local blood flow velocity. As a result, changes in venous and capillary blood flow as well as in transmural pressure across the vessel walls may occur.

The flow alterations generated by these pressure changes produce mechanical forces on the vascular wall, known as shear stress. Shear stress is considered an important physiological stimulus for the vascular endothelium. Experimental and clinical studies indicate that increased shear stress may contribute to the activation of endothelial signaling pathways. Among other mechanisms, this can involve activation of endothelial nitric oxide synthase, resulting in increased release of nitric oxide. Nitric oxide plays a key role in the regulation of vascular tone, endothelial function and microcirculation.[10][11]

Changes in local blood flow and shear stress are also regarded as important mechanisms in the adaptation of blood vessels to hemodynamic stimuli. Studies on flow-mediated dilation suggest that alterations in shear conditions play a central role in the regulation of vascular function.[12]

Studies investigating intermittent negative pressure applied to the lower limbs further suggest that such pressure changes may influence both macrovascular and microvascular circulation.[13]

Clinical relevance of microcirculation

Microcirculation plays a central role in the delivery of oxygen and nutrients to tissues and in the removal of metabolic waste products. The microvascular network, consisting of arterioles, capillaries and venules, represents the primary site of exchange between blood and tissues. Proper microvascular perfusion is therefore essential for maintaining normal cellular metabolism and tissue function.[14]

Disturbances of microcirculation have been associated with a variety of pathological conditions, including cardiovascular disease, diabetes mellitus, impaired wound healing and age-related vascular dysfunction. Alterations in endothelial signaling, blood flow regulation and capillary recruitment are considered important mechanisms contributing to these disorders.[15]

Therapeutic approaches aimed at improving microvascular blood flow are therefore of interest in several fields of medicine, including vascular medicine, rehabilitation and sports medicine. Interventions that modify local hemodynamic conditions and shear stress may contribute to changes in endothelial function and tissue perfusion.[16]

Treatment

The average treatment duration, according to indication, amounts to 4 to > 10 applications (30–45 minutes). There are numerous indications for the intermittent vacuum therapy, however you still find a great need for research since findings are not always distinct enough. Indications are amongst others: Connective tissue weakness, overacidification,[17] cellulite and spider veins, injuries (e.g. bruises or sports injuries[18]), vascular diseases, oedemata and ulcers.[19] Further indications which are already treated in the Netherlands are RSI syndrome, CTS (carpal tunnel syndrome), CRPS and the Raynaud syndrome.[20] No blindstudies available.

Contraindications

Negative effects could not be detected until now. Nevertheless, the IVT should not be conducted in case of acute injuries such as phlebothrombosis, thrombophlebitis, infections or pregnancy.

See also

References

  1. ^ Dong, Hui Hui; Gao, Bing Hong; Zhu, Huan; Yang, Sheng Tao (February 2019). "[The effects of lower limb intermittent negative pressure therapy on the skin microcirculation perfusion of quadriceps in male rowers]". Zhongguo Ying Yong Sheng Li Xue Za Zhi = Zhongguo Yingyong Shenglixue Zazhi = Chinese Journal of Applied Physiology. 35 (2): 126–129. doi:10.12047/j.cjap.5727.2019.028. ISSN 1000-6834. PMID 31250602.
  2. ^ Campisi, C. C.; Ryn, M.; Campisi, C. S.; Di Summa, P.; Boccardo, F.; Campisi, C. (December 2015). "Intermittent Negative Pressure Therapy in the Combined Treatment of Peripheral Lymphedema". Lymphology. 48 (4): 197–204. ISSN 0024-7766. PMID 27164765.
  3. ^ "Intermittent Negative Pressure Therapy" (PDF). Archived from the original (PDF) on 6 September 2012. Retrieved 17 June 2013.
  4. ^ Orletskiy & Timtschenko, 2009 / Ben T. A. Esch, Jessica M. Scott and Darren E. R. Warburton, 2007
  5. ^ Thijssen, Dick H. J.; Atkinson, Ceri L.; Ono, Kumiko; Sprung, Victoria S.; Spence, Angela L.; Pugh, Christopher J. A.; Green, Daniel J. (2014-05-15). "Sympathetic nervous system activation, arterial shear rate, and flow-mediated dilation". Journal of Applied Physiology. 116 (10): 1300–1307. doi:10.1152/japplphysiol.00110.2014. ISSN 1522-1601. PMID 24699856.
  6. ^ Orletskiy & Timtschenko, 2009
  7. ^ "Die intermittierende Vakuum-Therapie zur Behandlung von Sportlern". medicalsportsnetwork.de. Archived from the original on 21 June 2011. Retrieved 16 June 2013.
  8. ^ Löberbauer-Purer, Elisabeth; Meyer, Nanna L.; Ring-Dimitriou, Susanne; Haudum, Judith; Kässmann, Helmut; Müller, Erich (May 2012). "Can alternating lower body negative and positive pressure during exercise alter regional body fat distribution or skin appearance?". European Journal of Applied Physiology. 112 (5): 1861–1871. doi:10.1007/s00421-011-2147-1. PMID 21922264. S2CID 2578811.
  9. ^ "Lower Body Negative Pressure". nasa.gov. Retrieved 17 June 2013.
  10. ^ Moncada S, Higgs EA. The L-arginine–nitric oxide pathway. N Engl J Med. 1993;329:2002–2012.
  11. ^ Green DJ, Hopman MTE, Padilla J, Laughlin MH, Thijssen DHJ. Vascular adaptation to exercise training: role of hemodynamic stimuli. Physiol Rev. 2017;97:495–528.
  12. ^ Thijssen DHJ, Black MA, Pyke KE, et al. Assessment of flow-mediated dilation in humans: a methodological and physiological guideline. Eur Heart J. 2019;40:2534–2547.
  13. ^ Sundby ØH, Høiseth LØ, Mathiesen I, Weedon-Fekjær H, Hisdal J. The acute effects of lower limb intermittent negative pressure on macro- and microcirculation. PLoS One. 2017;12:e0179001.
  14. ^ Green DJ, Hopman MTE, Padilla J, Laughlin MH, Thijssen DHJ. Vascular adaptation to exercise training. Physiol Rev. 2017;97:495–528.
  15. ^ López-Otín C, Kroemer G. Hallmarks of aging: an expanding universe. Cell. 2023;186:243–278.
  16. ^ Green DJ, Hopman MTE, Padilla J, Laughlin MH, Thijssen DHJ. Vascular adaptation to exercise training. Physiol Rev. 2017;97:495–528.
  17. ^ Fonda, Borut; Sarabon, Nejc (July 2015). "Effects of intermittent lower-body negative pressure on recovery after exercise-induced muscle damage". International Journal of Sports Physiology and Performance. 10 (5): 581–586. doi:10.1123/ijspp.2014-0311. ISSN 1555-0265. PMID 25473823.
  18. ^ Beyzadeoğlu, Prof Dr Tahsin; Yildirim, Dr Kerem (2021-05-31). "Intermittent Vacuum Therapy after ACL Surgery". Sportärztezeitung (in German). Retrieved 2021-11-10.
  19. ^ Tuganbekov, Т; Ashimov, N.; Saipiyeva, D. (April 4, 2021). "Experience in the application of interval vacuum therapy with Vacumed device in complex treatment of lower extremity trophic ulcers" (PDF). Retrieved November 10, 2021.
  20. ^ "Vacuümtherapie - Een bewezen RSI-behandelmethode". Archived from the original on 2013-11-12. Retrieved 2013-11-12.

Further reading

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