Patient Information

Circulator Boot Therapy, a Safe Alternative to Amputation

By: Nancy Unsworth RN

I’m afraid we have no option left but to take your leg off, just below the knee." The words filter slowly through one’s mind. 48 years old, teenage daughter, a wonderful wife, diabetes and a wheelchair. The third round of IV antibiotics, PICC line, dressing changes, offloading, debridements and visits to the hospital and various physicians and clinics, has been unsuccessful and now the leg is no longer considered viable. The repercussions are tremendous. What about the other leg – how long before it becomes a problem too?

This is the all too familiar scenario for the person with diabetes. Even with client compliance and all that the health care system can offer today, the complications associated with loss of protective sensation, neuropathy, peripheral vascular disease and infection easily lead to the development of a foot ulcer that standard medical practice is unable to help. Amputation is the next course of action and the latest statistics point to a 40% chance of losing the other leg within 3 years. The loss in quality of life will be monumental and the sequelae of diabetes and peripheral vascular disease play on. The cost to the client is grave and the cost to the health care system is ongoing with surgery, rehab, home care… This is a harsh reality to face, and to add insult to injury, it is even more heart wrenching when one learns that it doesn’t have to be this way.

Over the past 20 years, Dr. Richard S. Dillon (Bryn Mawr, Philadelphia, USA) has developed The Circulator Boot and used it to successfully treat limb lesions associated with diabetes and peripheral arterial, venous and neuropathic disease. He has published documentation, ‘15 years of treating 2177 episodes with the Circulator Boot’ – Angiology Vol. 48, Number 5, Part 2, May 1997. There are at least a dozen major clinics in the USA (Mayo, Neumann, Gonda) that offer this therapy and Medicare often ‘foots’ the bill!

What is this Circulator Boot Therapy and how does it work? It is an end-diastolic pneumatic compression boot system, cardio-synchronous, shown to improve significantly most tests of peripheral arterial perfusion. It is designed to compress chosen portions of the leg when the heart is in diastole. It may be timed to compress after each heartbeat, every other heartbeat or every third heartbeat (for those with atrial fibrillation or severe PVD). This cardio-synchronous compression decreases cardiac afterload thus it also functions as a cardiac assist device (an advantage for all clients). The entire leg can be treated in the Long-Boot or the Mini-Boot can be used to treat a foot lesion.

This compression therapy is given in a series of daily treatments commonly lasting 40 minutes. Highlights of therapeutic effect are: improved hemodynamics, stimulation of fibrinolytic activity (ñblood flow), promotion of angiogenesis (ñnitric oxide), and the dissemination of antibiotics locally (if necessary). It is easily done on an out-patient basis in conjunction with a multidisciplinary care team. Indications for use: arterial insufficiency including rest pain, claudication, ischemic ulcers, persisting ischemia (post embolectomy or bypass surgery), insufficient blood supply (amputation site), threatened gangrene; venous disease including edema and induration, venous stasis ulcers; lymphedema. The only contraindication is that of deep vein thrombosis.

In summary, Circulator Boot Therapy is a noninvasive, safe alternative to amputation. It is a complementary treatment pre and post bypass surgery. It is an option for clients who are not candidates for surgery. It offers only positive effects on other potential forms of treatment. It is cost effective. There is no other boot like it – and no treatment even remotely comparable at the present time in Canada. It promotes revascularization in a limb thought unsalvageable!

After exhausting every resource and not being able to travel to the USA for treatment –this gentleman undergoes a below the knee amputation… Another client heads to a Florida clinic for Circulator Boot treatment of her diabetic foot lesion, to return home 3 months later almost completely healed with an improvement in her overall health. Are we as Canadians not entitled to timely and appropriate access to medical treatment that can improve quality of life and decrease the likelihood of future interventions which are more costly and less effective?

Let each of us help to make a difference in our health care! Advocate for the successful treatment of diabetic foot lesions and peripheral vascular disease. Give information to those people dealing with chronic wounds, PVD, diabetes and the threatening consequence of amputation. Talk to your Doctors, Nurses and Allied Health Care Professionals. We can make such a difference – educate as to the benefits of Circulator Boot Therapy. For treatment inquiries contact:

Dave Hanneson
Biomation
335 Perth St.
P.O. Box 156 
Almonte, Ontario K0A 1A0 
Tel:  (613) 256-2821 
Fax: (613) 256-5872
E-Mail: info@biomation.com
Web: www.biomation.com

Nancy Unsworth currently participates on a steering committee for the Canadian Pharmacists Association, is a member of Canadian Association of Wound Care (CAWC), National Association of Vascular Access Networks (NAVAN), and is on the Board of Governors of The Canadian Intravenous Nurses Association.

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