Haemodynamic effect of a leg compression bandage on the distal posterior tibial artery using 4D flow magnetic resonance imaging: A quantitative study

Abstract

The uncertainty concerning the physiological effects of compression bandaging on the peripheral blood flow is a challenge for healthcare professionals. The main objective was to determine the haemodynamic impact on the distal posterior tibial artery after the application of a high‐compression leg multicomponent bandaging system using 4D flow magnetic resonance imaging. Leg dominance disparities of the posterior tibial artery before and after the application of the compressive bandage were also analysed. Twenty‐eight healthy female volunteers were recruited (mean: 25.71, standard deviation: 4.74 years old) through a non‐probability convenience sampling. The 4D flow magnetic resonance imaging of the distal tibial posterior artery was performed in all participants, first under standard resting conditions and after the application of a compression bandage in the leg. When the strong compressive bandage was applied, the area of the assessed artery decreased by 14.2%, whilst the average speed increased by 19.6% and the flow rate increased by 184.8%. There were differences between the haemodynamic parameters of both legs according to dominance, being statistically significantly lower in the dominant leg. The application of strong compressive bandaging significantly increases the arterial flow and mean velocity in the distal segment of the posterior tibial artery, in healthy volunteers by 4D flow magnetic resonance imaging. In this study, leg dominance influenced some of the haemodynamic parameters. According to the results, leg compression bandages cannot be contraindicated in vascular ulcers with arterial compromise.

1. INTRODUCTION

Compression therapy is one of the most common therapeutic approaches for certain vascular pathologies of the lower limb and their consequent skin ulcers. ¹ , ² Regarding ulcers associated with circulatory impairment of the lower limb, almost 1% of the world's population is affected, with a higher prevalence in the elderly population. ³ About 81% of the ulcers have a venous origin, and 16.3% are directly related to peripheral arterial disease. ⁴ The combination of venous and arterial pathology is found in 10%–20%. ³ Peripheral vascular pathology entails high costs and a decrease in patients' quality of life. ⁴ , ⁵

Compressive bandaging is the most widely used and effective therapy for high‐pressure venous ulcers, ² , ⁵ , ⁶ although there is no consensus about the most adequate application method. ⁷ , ⁸ The application of compression bandage has been considered a contraindication in the presence of arteriopathy due to the possible association of an ischemic effect induced by the bandage. ⁵ , ⁹ , ¹⁰ In arteriovenous ulcers, the lack of application of this treatment means that the venous part of the disease is ignored, delaying the healing process of the ulcer. ¹¹ The existing evidence on this treatment for those ulcers is still insufficient or low and there is little agreement on the pressure used. ⁵ , ¹²

Noteworthy, it is not infrequent an incorrect and unsafe application of the dressing due to the lack of knowledge about the physiologic effects of compression therapy. ⁴ , ⁷ Inadequate treatments can be detrimental, may cause serious injury or delay wound closure, inducing associated risks and complications that have an impact on the healing process. ¹² Healthcare professionals, who are usually responsible for the application of compression therapy, should have a thorough understanding of the assessment, pathophysiology, healing process and application of compression bandages for lower limb ulcers. ¹³ , ¹⁴ For instance, the optimal pressure to be applied is not well established ⁵ , ¹¹ , ¹⁵ and there is a lack of standardised criteria and unified protocols for the therapeutic management of different types of ulcers. Very often the decisions for application of compression therapy are based on their own experience and skills and not on clinical evidence. ¹² , ¹⁶ , ¹⁷ Increased knowledge of compression therapy will have a positive impact on patients by laying the foundation for appropriate compression therapy. ⁷ , ⁸

Before initiating compression therapy in patients with lower limb ulcers, the function of the arterial system should be assessed to apply the appropriate pressure. To this end, several non‐invasive diagnostic tools have been developed namely: plethysmography, Doppler ultrasound and blood pressure indices. Currently, doppler signal and Ankle‐Brachial Index (ABI) or pressure at the ankle level are universally accepted to decide if applying compression or not. The clinical practice guidelines of the Society of Vascular Surgery and the American Venous Forum establish an ABI cutoff of 0.5 to decide compression in mixed ulcers. ¹⁸ In patients with a venous leg ulcer and underlying arterial disease, compression bandages or stockings are not recommended if the ABI is 0.5 or less or if absolute ankle pressure is less than 60 mmHg. The same cutoff proposal has been reported more recently in the European Society for Vascular Surgery SVS guidelines. ¹⁹ The assumption that an ABI of less than 0.5 is indicative of severe arterial disease still appears to be a valid statement. ²⁰

Despite their routine use of ABI and Doppler signal, these methods are still clinically valid and have certain limitations in the precise detection of arterial deficits as they are indirect measures of arterial flow and pressure. ²¹ Therefore, other radiodiagnostic tools such as magnetic resonance imaging (MRI) have been tested in recent years for the assessment of peripheral arterial diseases. ²² The recently developed four‐dimensional flow (4D flow) is a technique of MRI that captures flow images in four dimensions (three spatial and one temporal). The 4D flow MRI has the advantage over previous methods that provide highly relevant quantitative and visual information on anatomical and physiological parameters in a non‐invasive way, without ionising radiation. It enables simple scanning in a single acquisition of a large three‐dimensional volume, with minor operator dependence for precise flow measurement and allowing retrospective data analysis. ²³ Currently, it has been mainly used to assess cerebral, coronary, pulmonary, thoracic, abdominal, renal, iliac and proximal femoral arteries. ²³ , ²⁴ However, to the best of our knowledge, no lower limb studies have been found with distal posterior tibial measurements.

A favourable evolution of vascular ulcers in the lower limbs is related to an adequate knowledge of its physiology, pathophysiology and/or aetiology. ²⁵ Previous studies report that the health professionals responsible for the care of these conditions, do not have the theoretical and practical knowledge necessary for the correct healing and prevention of ulcers of vascular origin. In addition, the lack of training, both practical and theoretical, of the professionals who apply compression treatment is evident, as there is little documentation with clear interventions to be conducted by professionals to achieve healing and prevent recurrence. ²⁵ , ²⁶ Several studies ¹⁵ , ²⁷ refer to the importance that health care providers who deliver compression therapy, as doctors and nurses, must have sufficient skills to be competent in the application of the treatment, a key element in achieving effective compression. Therefore, it is necessary for professionals, to have the required knowledge and skills in their interventions to ensure the success of evidence‐based treatments.

Our hypothesis is that the application of a strong compressive bandage on the lower limb does not cause a restriction of arterial circulation at the distal level but induces, contrary to what some authors have suggested, an increase in arterial flow and velocity when analysed by 4D flow MRI. To explore this hypothesis and to obtain solid haemodynamic information, the following objectives were defined. First, to determine the haemodynamic impact on the distal posterior tibial artery after the application of a high compression multicomponent bandage system and to describe the differences in arterial area, flow and velocity using 4D flow MRI. Secondly, to study whether leg dominance is associated with differences in area, flow and mean velocity of the posterior tibial artery before and after applying a compression bandage.

2. MATERIALS AND METHODS

2.1. Study design and participants

For this experimental, longitudinal study, 28 female volunteers were recruited through a non‐probability convenience sampling. Inclusion criteria were defined as follows: female from 18 to 38 years of age with a body mass index <24 kg/m² and an ankle circumference <25 cm. The following conditions were considered as exclusion criteria: prior vascular pathology, including recent trauma or skin disorders in the lower limbs; any previous pathology affecting the circulatory and locomotor system, including recent trauma and skin alterations in the lower extremities; suffering from claustrophobia; recent tattoos; not having had at least 8 h of rest the night before; physical exercise on the day of the test; having ingested stimulating substances such as coffee or tea on the day of the session; wearing tight‐fitting clothing on the day of the test; wearing earrings or metallic objects on the day of the test and being pregnant or under period of breastfeeding.

Volunteer recruitment involved outreach via the research group's social media platforms, inviting participation. Upon indicating interest, volunteers received comprehensive written information detailing the study's procedures, objectives and inclusion/exclusion criteria. Following confirmation of their willingness to participate, volunteers underwent interviews to ascertain their alignment with study requirements, culminating in the formation of the final sample.

2.2. Study setting and data collection

Data collection was recorded between August and November 2019 in an MRI diagnostic centre. To compare the possible haemodynamic changes in the lower limb after the application of a compressive bandage system, the UrgoK2® two‐layer system (URGO Group, URGO Medical Division, Chenôve, France), which provides a high degree of pressure, was used. This method combines two bandages of different elastic behaviour, both with a force indicator to obtain the pressure recommended by the manufacturer and to be distributed through its components. The anagram drawn on the different tissues must transform its initial morphology and become a circle after stretching and applying the bandages around de lower limb. In this way, it is possible to maintain fairness with respect to the tension used, which causes the pressure exerted by the bandage for all applications. According to the manufacturer, this ensures a therapeutic pressure of about 40 mmHg at the ankle with a gradual decrease towards the knee. All intervention on the application of the bandages was carried out by the principal investigator.

The radiodiagnostic tool employed was the Siemens Healthineers Nuclear Magnetic Resonance Imaging system, Magnetom Vida 3 Tesla model, with software version syngo MA XA11. In addition, the PA1–PA6 chest coil with 64 channels was used to acquire the complete volume of both lower extremities simultaneously. Placement of thoracic electrodes (cardiac and respiratory gating) and a pulse oximeter were necessary for heart rate synchronisation.

Three main haemodynamic parameters of the posterior tibial artery of the lower limbs were measured: mean arterial blood velocity (cm/s), area of the chosen arteria (mm²) and flow rate (mL/s). These parameters were measured from each of the two legs twice, first under standard conditions and then with a compression bandage applied.

2.3. Study protocol

After anthropometric measurements were taken, the volunteer laid down on the MRI table in a supine position to undergo the first of two tests, without compression (no bandage), to assess the baseline haemodynamic status. The feet were joined without pressure using adhesive tape to minimise variation in position. The imaging parameters used were: tilt angle of 20°, echo time of 3.7 ms, repetition time of 45.9 ms, the field of view of 400 and 350 mm² for sagittal coverage, slice thickness of 7 mm in axial orientation and 96–105 mm in coronal orientation. 4D flow phase‐contrast sequences were used with a velocity encoding sensitivity of 10 cm/s, as well as 3D T1 sequences with the same geometric parameters as the 4D flow sequences, to achieve better anatomical localisation. The spatial and temporal resolution of the pulse sequence was adjusted for data acquisition with a total scan time of less than 15 min for normal heart rates.

After the first MRI test, UrgoK2® high compression spiral bandages were applied to both lower limbs, starting from the head of the metatarsals, with a 50% overlap of layers, as recommended by the manufacturer. In addition, to ensure proper constant force application resulting in correct compression, the pressure indicator printed on each bandage was meticulously used. After the immediate application of the bandages, the volunteer underwent a second MRI.

The anatomical area used for haemodynamic measurements of the area and arterial flow corresponded to the most distal aspect of the posterior tibial artery. The range of variation in relation to the mean of the 112 measurements was ±4 cm with respect to the upper and lower limits.

2.4. Sample size

Sample size and power estimations were calculated to achieve 80% power paired t‐tests with a 0.05 significance level to detect differences amongst the means versus the alternative of equal means of d = 0.6. These requirements would be met considering at least 24 pairs of records, and we measured 28 participants.

2.5. Data analysis

Shapiro–Wilk and Levene tests were used to evaluate the normal distribution of data. Numeric variables were described as mean and standard deviation (SD) or median and interquartile range (IQR), as appropriate. Categorical variables were presented in absolute frequencies and percentages. Pearson correlations were used to measure the association between numeric variables. Paired t‐tests and Wilcoxon signed‐rank tests were used as appropriate to study the differences in the 4D flow MRI measurements between conditions (i.e. with or without compression bandage). To test the possible influence of the leg (i.e. either right/left or dominant/non‐dominant) in addition to that of the condition on the measurements, repeated measures two‐way ANOVA or ranked mixed‐effect models were used, as appropriate. In this last test, only participants for whom measurements on both legs were available were considered. No extreme values were eliminated. The statistical significance level was set to 0.05. All analyses were carried out in R 4.2.0.

2.6. Ethical considerations

The Ethics Committee of the Valencia Catholic University Saint Vincent Martyr approved the study protocol and registered under the number UCV/2015‐2016/58. All participants recruited in the study signed informed consent to participate. This study was carried out in accordance with the European recommendations of Good Clinical Practice and the principles of the Declaration of Helsinki.

3. RESULTS

After applying the inclusion and exclusion criteria, 28 participants completed the study. All participants were female, 25.71 (SD: 4.74) years old, 1.65 (0.06) metres in height, 56.29 (6.33) kg in weight and 89.3% right‐handed. All participants but one was measured in both conditions on both legs, giving a total of 55 legs. The complete descriptive statistics of the three haemodynamic parameters can be found in Table 1.

TABLE 1.

Descriptive statistics of the three haemodynamic parameters under different conditions.

Variable	Mean	Standard deviation	Median	Interquartile range	Condition	Mean	Standard deviation	Median	Interquartile range	Leg	Mean	Standard deviation	Median	Interquartile range
Area	44.48	24.1	41.12	22.68	Normal	47.9	24.16	44.30	18.26	Non‐dominant	48.47	27.89	44.63	13.50
										Dominant	47.32	20.30	43.26	21.95
					With CB	41.07	23.77	34.38	22.93	Non‐dominat	39.46	24.85	30.44	26.41
										Dominant	42.68	23.00	36.55	17.82
Average speed	0.93	0.39	0.84	0.44	Normal	0.85	0.39	0.76	0.49	Non‐dominat	0.90	0.44	0.79	0.63
										Dominant	0.80	0.33	0.73	0.28
					With CB	1.02	0.39	0.96	0.34	Non‐dominat	1.14	0.41	1.02	0.32
										Dominant	0.89	0.32	0.84	0.34
Flow rate	0.16	0.41	0.07	0.31	Normal	0.08	0.42	0	0.37	Non‐dominat	0.28	0.41	0.16	0.32
										Dominant	−0.12	0.32	−0.11	0.18
					With CB	0.23	0.4	0.11	0.26	Non‐dominat	0.37	0.46	0.23	0.24
										Dominant	0.09	0.26	0.01	0.23

Figure 1 shows the differences in the area of the posterior tibial artery of the lower limbs (Wilcoxon signed rank test, V = 954, p‐value = 0.069), average speed of the blood (Wilcoxon signed rank test, V = 323, p‐value <0.001) and flow rate (Wilcoxon signed rank test, V = 348, p‐value <0.001) when applying the compressive bandage. When the bandage was applied, the area decreased by 14.20% (−6.83 ± 34 mm²), although not statistically significant. The variables related to average speed and flow rate increased by 19.58% (0.16 ± 0.31 cm/s) and 184.83% (0.15 ± 0.40 mL/s), respectively. When considering the possible two‐way effect combining the application of the bandage and the leg measured (i.e. right/left) these statistically significant differences were maintained (see Table 2). In addition, the leg side had a statistically significant effect on all the variables measured except for the area. In none of the cases was the interaction of leg and bandage application statistically significant.

FIGURE 1.

Differences in 4D flow MRI measurements according to the condition (normal: without compressive bandage; with CB: with compressive bandage). Lines represent how each measure varied per leg between conditions. Units: area (mm²), average speed (cm/s), flow rate (mL/s). *** for p‐value ≤0.001.

TABLE 2.

Two‐way repeated measures significance. Ranked linear mixed‐effect models were fitted for area, average speed and flow rate, and ANOVA for flow rate/area.

	Area (mm2)		Average speed (cm/s)		Flow rate (mL/s)		Flow rate/area (mL/s mm2)
	F‐value	p‐value	F‐value	p‐value	F‐value	p‐value	F‐value	p‐value
Condition (normal/with CB)	5.26	0.025	14.84	<0.001	12.98	<0.001	23.57	<0.001
Leg (right/left)	0.73	0.40	11.35	0.001	62.80	<0.001	38.75	<0.001
Condition*leg	0.32	0.57	1.91	0.17	2.81	0.097	0.02	0.88

Figure 2 shows the differences associated with leg dominance in each condition. There were no differences in terms of area in both conditions. When the compressive bandage was applied, the area decreased independently of the dominance, although it decreased more in the non‐dominant leg (not statistically significant). Regarding the average speed, there were no differences without the bandage according to the dominance but increased when applying it, being higher in the non‐dominant leg. The flow rate was higher in the non‐dominant leg and increased when applying the compressive bandage, regardless of dominance. These statistically significant differences were maintained when considering a possible two‐way effect of the dominance of the leg, having the dominance a statistically significant effect in all the variables except for the area and no interaction being statistically significant, as seen in the previous analysis (see Table 3). No adverse events were found in any intervention.

FIGURE 2.

Differences in 4D flow MRI measurements according to the condition (normal: without compressive bandage; with CB: with compressive bandage) and the dominance of the leg. Units: area (mm²), average speed (cm/s), flow rate (mL/s). ** for p‐value ≤0.01, *** for p‐value ≤0.001, **** for p‐value ≤0.0001.

TABLE 3.

Two‐way repeated measures significance using ranked linear mixed‐effect models.

	Area (mm2)		Average speed (cm/s)		Flow rate (mL/s)		Flow rate/area (mL/s mm2)
	F‐value	p‐value	F‐value	p‐value	F‐value	p‐value	F‐value	p‐value
Condition (normal/with CB)	5.06	0.027	17.43	<0.001	14.04	<0.001	22.61	<0.001
Dominance (non‐dominant/dominant)	0.58	0.44	12.54	<0.001	60.15	<0.001	74.08	<0.001
Condition*dominance	0.21	0.65	2.76	0.10	2.23	0.14	0.48	0.49

4. DISCUSSION

The results of this study provide the first‐ever description of the haemodynamic effect exerted by the application of a high‐compression compressive bandage on the distal segment of the posterior tibial artery in the lower limb, using the 4D flow MRI technique. To date, there are no known studies that have employed this tool for this purpose. The application of the compressive bandage increases the mean velocity and flow in the selected artery. However, it does not produce any statistically significant difference in the area.

Focusing on the finding of a statistically significant increase in arterial flow after high compression, we observe that our overall results and conclusions align with the same direction as other previous studies that have used indirect measurement tools on arterial circulation through the microcirculation, tissue perfusion, ankle and toe pressures. ¹¹ , ¹⁶ , ²⁸ Some of these methods present a limited perspective of microcirculation in a specific area of the skin, especially in the presence of symptoms and signs of advanced chronic venous insufficiency. ¹¹ , ¹⁶ Thus, they claim that arterial circulation under inelastic compression (up to 30–40 mmHg) is not impeded, ¹¹ and even exhibits an increased flow rate. ¹⁶ , ²⁸ , ²⁹

Regarding the increase in arterial flow velocity, our results are in accordance with other published studies. ²⁸ , ²⁹ However, previous studies mainly refer to the effect on the venous microcirculation, as compression leads to a reduction in vessel diameter. ³⁰ The acceleration of capillary flow could lead to the release of anti‐inflammatory mediators, ⁸ reduction in pro‐inflammatory cytokines, pain relief and even ulcer healing with adequate compression. ⁹ , ¹⁶ , ³⁰ On the other hand, when compared with the theory of fluid dynamics physics, our results are consistent in observing an increase in arterial blood flow and velocity following the application of a high‐compression bandage system. Regarding the variation of the vessel area at the distal posterior tibial artery, a significant decrease was not found after compression. In fact, in relation to the principles of fluid dynamics physics, if the area is decreased, velocity and flow should increase. ¹⁰

According to the literature on the physiological effects and benefits of compression therapy, there is consensus regarding the improvement of the venous and lymphatic system return. ³¹ However, the increase in arterial flow and velocity is not emphasised, although it becomes evident when directly analysed with the 4D flow MRI technique used in this study.

Interestingly, upon analysing the dominance of the legs on vascular parameters under both conditions (without compression bandage and with compression bandage), it was observed that the ‘flow rate’ was higher in the non‐dominant leg. The difference in flow rate between the dominant and non‐dominant leg remained consistent with and without the compressive bandage. However, no statistically significant differences due to dominance were found in the area of the distal posterior tibial artery. In terms of average velocity under baseline conditions, there were also no dominance‐associated differences. Nevertheless, the application of the compressive bandage generated a statistically significant difference between the two legs. In other words, the compressive bandage increased the velocity more in the non‐dominant leg than in the dominant leg. Few studies have considered the effect of dominance between lower limbs on peripheral circulation. ³² , ³³ , ³⁴ A study conducted on athletes describes variations in vascularisation of the upper extremities depending on dominance. ³⁵ Further studies considering limb dominance seem necessary to delve into the consequences of compression application.

The 4D flow MRI emerging technology is unprecedented with numerous advantages over conventional diagnostic tools and offers a comprehensive assessment of vascular haemodynamic. This technique provides valuable information to better understand the role of flow dynamics in healthcare, including a preventive approach. ²³ , ³⁶ In contrast to 4D flow MRI, vascular ultrasound techniques cannot be used in a certain percentage of patients due to pain, ulceration, oedema, obesity and calcified arteries. ²¹

In the context of mixed arteriovenous ulcers, the use of modified, reduced, or supervised compression therapy (20–40 mmHg) has been recommended. ⁸ , ¹¹ , ¹⁶ According to the manufacturer's recommendations for the UrgoK2® bandage system, and as reflected in the literature, ³ compressions should not be applied in the presence of known or suspected arterial involvement, amongst other warnings. In venous ulcers, the mechanism and benefits of compression therapy are already demonstrated. ³⁷ On the contrary, there are still some controversial issues concerning the treatment of mixed ulcers. ⁴ , ⁵ , ²⁵ Disagreements are focused on the use of compression for ABI between 0.6 and 0.8. ¹⁷ Most recent publications are in favour of reduced compression therapy (<40 mmHg) in cases of mixed ulcers with moderate arterial impairment. ¹⁶ , ¹⁹ A panel of experts ⁸ , ³⁸ and a recent international consensus statement ¹⁹ have established that compression should be contraindicated in critical limb ischemia (ABI <0.5; ankle pressure <60 mmHg) but not in moderate arterial disease.

Our research reinforced the current recommendation of compression therapy in the presence of moderate arterial disease. It is important to note that the results described are derived from a healthy young population, and therefore cannot be directly extrapolated to patients with peripheral vascular pathology. However, from the current findings, the option of applying compression bandaging to a patient with mild or moderate arterial involvement could be considered safe, since this research has shown that arterial flow and velocity are significantly enhanced following its application.

Using 4D flow MRI, several peripheral flow adaptations at the distal tibial artery under a strong compression bandaging could be identified. The objective recorded haemodynamic variables without negligible observer variation would contribute to a greater understanding of vascular physiology, aiding in determining more precisely when high compression should not be recommended. Further studies are needed to address the haemodynamic differences found in patients with peripheral vascular diseases under compression and between the dominance of legs within the same subject.

The findings obtained through 4D flow MRI technology have significant clinical implications, as they imply a paradigm shift in establishing appropriate assessment of patients with peripheral vascular pathology particularly of arterial origin. In such conditions, the objective of the treatment protocol is to accelerate the healing process of cutaneous ulcers and reduce tissue injury rates. ³⁰

Finally, it seems crucial for healthcare professionals to have an in‐depth understanding of the pathophysiology and proper approach to develop effective treatment strategies. ¹⁰ , ²³ Compression therapy may be more beneficial if the ulcer has developed on the non‐dominant leg, as a greater increase in arterial flow has been observed compared to the dominant leg. Further studies should confirm the results found in this study on flow differences according to leg dominance, all ulcer care providers should be aware of this situation. Whether the lesion is on one leg or the other could be a predictor of progression.

4.1. Limitations

The study population consisted of healthy female subjects to form a more homogeneous sample and avoid potential influence from external variables such as differences in age and muscular volume related to sex. Findings from the literature indicate small differences between men and women in vascular network pressure in the lower extremities. ³⁹ These differences have been linked to different muscular development in men. Moreover, variability in pressure following compressive venous occlusion is greater in men than in women. These potential confounding factors were addressed by exclusively studying women within the same age range. Based on previous studies, the inclusion of men would have introduced greater result dispersion.

It is also pertinent to acknowledge that the findings presented are based on observations from a cohort of healthy, young individuals, and thus, direct extrapolation to patients with peripheral vascular pathology should be done cautiously. In future investigations, it will be necessary to include both sexes and make comparisons between them. As no previous studies using the 4D flow MRI tool in the distal lower limb were found, comparisons were made with similar studies conducted using other techniques.

Another limitation of the current research is that the compression exerted by the UrgoK2® bandage was not measured after its application. Therefore, the amount of pressure could vary somewhat in the participants, even if the same nurse applied the bandage as in our study. In this sense, it has been reported that ‘expert nurses’ applied the same bandage with a compression pressure ranging from a few mmHg to >140 mmHg. ⁴⁰ However, the bandage we used, with printed marks aiding the application method, and applied for the same nurse, can greatly narrow the desired pressure range.

In future work, it would be beneficial to assess the effect of compression bandaging in subjects with peripheral vascular pathology using the 4D flow MRI technique. Measurements were taken immediately after applying the bandage. In subsequent studies, measurements over an extended period would be required to evaluate whether the obtained variations are sustained or if they are instead a result of physiological adaptive reactions.

5. CONCLUSIONS

The application of a strong compression bandage on the leg statistically significantly increases arterial flow and mean velocity in the distal segment of the posterior tibial artery of the lower extremity in healthy young females. Measurements were performed by 4D flow MRI in a group of healthy volunteers. Although there was a minor reduction in vascular area, this decrease did not reach statistical significance. Furthermore, this research has identified that certain haemodynamic parameters are affected by leg dominance. This aspect should be considered when applying a compression bandage.

CONFLICT OF INTEREST STATEMENT

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Garrigues‐Ramón M, Arca‐Arias A, Carrasco‐Ribelles LA, Barrios C. Haemodynamic effect of a leg compression bandage on the distal posterior tibial artery using 4D flow magnetic resonance imaging: A quantitative study. Int Wound J. 2024;21(7):e14901. doi: 10.1111/iwj.14901

DATA AVAILABILITY STATEMENT

Raw data are available upon reasonable request to corresponding author.