The importance of the ankle region in venous disease and treatment cannot be overestimated. It bears the skin changes of pigmentation, eczema, fibrosis, lipodermatosclerosis, atrophie blanche and ulceration that defines the later stages of venous disease. It is believed that a sustained venous pressure elevation in the ankle region from venous insufficiency is the primary cause of venous skin changes. This may be because it has no pump of its own being situated between the foot pump and the calf pump.
The Cockett-I perforating vein is situated posterior and inferior to the medial malleolus. It is the highest perforating vein that has an outward flow direction. Consequently, activation of the foot pump causes pressurisation of the superficial veins draining the foot (centripetal venous pressure). Direct pressure over this vein has the potential to reduce superficial venous pressure by diverting flow into deep veins.
Devices that can reduce the pressure on the Cockett-I region directly, or by increasing the efficiency of the foot/calf muscle pump, may alleviate the damaging effects in the later stages and reduce pain and swelling in the earlier stages. A discrete powerless intermittent compression device which can perform both actions is discussed.
HANS-JOACHIM GÜNTHER During walking venous blood flow from the leg back to heart is done mainly by compression of the calf-muscles. Furthermore, augmented flow in the deep veins would be desirable to avoid DVT and help alleviate swollen ankles and legs. Intermittent compression of the Cockett-I perforating veins (ICCV) is a new principle designed to improve the pumping performance of the foot and calf by increasing the flow in the deep veins of the leg.
The device (Teveno®) consists of 2 interconnected air-chambers. One is placed under the heel and the other over the Cockett-I perforating vein(s). The unit is held in place with a class 2 graduated elastic compression stocking.
In our tests on 100 legs using ICCV we demonstrated that the flow rate on duplex ultrasound in the popliteal vein was 600% higher than stationary standing and 100% higher than wearing compression stockings alone. The combination of ICCV and class 2 compression leads to a significant higher flow in the deep venous system.
In health the Cockett-I perforating veins have outward flow into superficial veins.
The ICCV device compresses the Cockett-I perforating vein when the heel strikes the floor.
Popliteal vein flow (cm/s) increases during weight bearing back onto the heel. This is augmented when the ICCV device is applied.