Hrev_master Veins and Lymphatics 2018; volume 7:7622 [Veins and Lymphatics 2018; 7:7622] [page 59] Pressotherapy with adjustable high-pressure gradients Claude-Julien Cartier Cabinet Médical, Châtearoux, France Abstract Our team is presenting a new therapeu- tic concept based on the important experi- ence acquired around the mercury fluid’s strong internal hydrostatic pressures in vas- cular and post-traumatic therapy. Currently, the objective is to extend the physical recourse to strong pressures without mercu- ry to carry on the advantages and open up to other performances. Context When looking for the tissue complica- tions of scuba diving in the literature, we do not find any. Yet the soft parts of the body receive 1 bar of extra pressure every 10 meters deep. In apnea, we can easily reach 3 to 10 extra bar. With bottles, we go down much deeper and a lot longer. 1 bar is the atmospheric pressure on the cutaneous surfaces at sea level. 1 extra bar is a familiar pressure for the plantar lym- phatics when walking, and this pressure is greatly increased during jogging and jump- ing. 1 bar is the maximum pressure of the high gradients known and used on the human body (mercury). Professor Henri Boccalon (Vascular Physician, Rangueil University Hospital of Toulouse), performed isotopic lym- phoscintigraphy in 1992 before and after treatment with Mercurial Pressotherapy of 30 primary and secondary lymphoedemas of the lower limbs by monotherapy: i) 13 flow improvements; ii) 16 unchanged states; iii) 1 single aggravation on recur- rence of cancer, with clinical improvement. Today, after 30 years of Mercurial Pressotherapy and more than 2,000,000 patients treated (medical practices, hospi- tals): no early or late deleterious effects in the usual results on loosening, volume reduction, healing.1-5 Therefore, all these data seem to allow us to go further in the use of strong pres- sures safely applied to vascular diseases in limbs. Argumentary How and why apply high-pressure gra- dients? We know the physiological interest of the continuous diurnal compression stok- ings on liquid transfers (10 to 40 mmHg). The compression can also be applied in a discontinuous, and even paroxysmal mode: i) equal pressure: nothing happens and the tissue fluids settle in depth; ii) degressive compression with low pressure gradient (=existing pressotherapies, less than 200 mmHg): the action is absorbed quickly in the first support tissues, in pro- portion to the magnitude of the applied pressure gradient; iii) this explains the major physiological interest of applaing high pressure gradients, between 200 mmHg and 760 mmHg (level of the mercu- ry pressotherapy). In the compressed territories, volume decrease and the relaxation of the intersti- tium and lymphatic canals restores the nec- essary flexibility to the physiological action of pumping macro-proteins; as soon as the pressures get stronger, the action is trans- mitted in depth, where the tissues are the most diversified and the lymphatic vessels are the rarest, physiologically overflowing: all the support tissues, muscular compart- ments, aponeuroses, neurovascular sheaths, tendons, articular areas, periosteum; this action involves moreover a tightening effect on the arteriolar vasodilator endothelium with reactive hyperaemia and macroscopic permanent erythrosis. Here, the vasodilata- tion takes place in a territory emptied of any venous content to stimulate the increase of the tissue oxygenation turn over. This has been schown by the study carried out at INSEP by Dr. Jousselin in 1990, which demonstrates, on the lactate levels decreas- es, the acceleration of the return to muscular aerobiosis in active sports recovery with strong pressure gradient, which was not atchieved with the low-pressure therapies that have been tested. Method The treatment that we propose is a grad- ual paroxysmal discontinuous compression. - Initial treatment: 3 to 4 sessions of 30 minutes spaced at intervals of 1 to 8 days. - Maintenance treatment: 1 session after 1 month, then 3 months, then every 6 months or once a year and when neces- sary according to evolution. The patient is lying down and relaxed while leaning his torso. Equipment We turn to compressed air in a charac- teristic stack of multiple pockets, using a gradient smoothing method on the limbs. Variable pressure gradients ranging from the upper limit of the existing pres- sotherapy to the studied hydrostatic pres- sures of mercury are programmed. The maximum peripheral pressures can be reported higher on the limb. In pure lym- phatic pathologies, the device dispenses proximal ganglionic pressures. The con- tention is widely used around treatments. Input What is innovative and makes a differ- ence with the existing Pressotherapies: - the set of pressure macro gradients (0, 2 to 1 bar); - the deep action; - the transfer of the maximum pressures; - the evacuation/vasodilatation conjunc- tion; - the induced aerobiosis. Compared with Mercurial Pressotherapy: - the performance without mercury; - the absence of environmental con- straint; - the position at rest during treatment; - the small size of the device, its mobility, its lightness, its cost. Proposed pressure gradients will have 3 possible uses: - medical and paramedical (the first to be developed); - sports fields, fitness, spas; - well-being and aesthetics. Target of the medical environ- ment - Venous and veno-lymphatic pathologies Correspondence: Claude-Julien Cartier, Cabinet Médical, 7 Rue Albert 1er, 36000 Châteauroux, France. E-mail: mlaure.cartier11@yahoo.fr Conference presentation: International Compression Club (ICC) Meeting, Paris, 2017. This work is licensed under a Creative Commons Attribution 4.0 License (by-nc 4.0). ©Copyright C-J. Cartier, 2018 Licensee PAGEPress, Italy Veins and Lymphatics 2018; 7:7622 doi:10.4081/vl.2018.7622 No n- co mm er cia l u se on ly Conference Presentation [page 60] [Veins and Lymphatics 2018; 7:7622] (sequelae of thrombosis, pain, heavi- ness, edemas, hypodermitis, ulcers); - Sequelae of trauma (sprains, fractures, tears, algoneurodystrophy); - Sport pathologies and traumas; - Primary and secondary lymphedemas, early or old; - Prevention of late edemas; - Mixed pathologies; - Contraindicated arterial surgeries for the elderly. Currently, the proof of concept is estab- lished and we will produce the prototypes in spring, for technical and then medical experiments. References 1. Cartier CJ. Mercury bath pressotherapy, indications, results. Phlebologie-SFP 1988. 2. Cartier CJ. Pressoyherapy by mercury in the treatment of limphedemas. J Malad Vascul 1990;15. 3. Cartier CJ. Edema physical treatment by mercury. Eur J Lymphol 1992;3:10. 4. Cartier CJ. Mercury pressotherapy (P.M.). Angiologie 2000;52. 5. Schadeck M. Pressotherapy with bath of mercury in the hypodermitis treat- ment. Phlebologie-SFP 2001;54. No n- co mm er cia l u se on ly