Impact of Leg Compression on Arterial and Skin Blood Flow: A Scoping Review

Abstract

Leg compression is used clinically to treat edema, lymphedema, and vascular disorders, but its effects on arterial and skin blood flow remain incompletely defined. This review evaluated hemodynamic responses to different compression modalities. A systematic search of MEDLINE, EMBASE, and Web of Science identified 443 articles. After screening and appraisal, 37 studies met the inclusion criteria, of which 33 reported quantitative changes in leg arterial blood flow (LBF) and 11 reported changes in skin blood flow (SBF). Across the LBF studies, 28 (85%) found an increase, four (12%) reported a decrease, and one (3%) showed mixed results. Intermittent pneumatic compression (IPC) and stockings produced the most consistent increases, particularly when applied during activity or over longer durations, while excessive static or high-pressure compression occasionally reduced flow. An increase of 29% to over 300% was reported, with improvements observed in both healthy individuals and patients with peripheral arterial disease, critical limb ischemia, or intermittent claudication. For SBF, eight studies (73%) showed an increase, two (18%) showed a decrease, and one (9%) demonstrated mixed findings. IPC consistently augmented SBF, often by >90%, with combined foot and calf compression producing the largest gains. In contrast, excessive external pressure reduced perfusion, highlighting the importance of the compression level. Bandaging improved SBF in venous ulcer patients but reduced it in healthy controls at high pressures. Overall, compression therapy most often increased LBF and SBF, though effects varied with modality, applied pressure, and patient population. These findings emphasize the need for modality- and dose-specific application when using compression to enhance lower extremity perfusion.