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Intermittent negative pressure applied to the lower limb increases foot macrocirculatory and microcirculatory blood flow pulsatility in people with spinal cord injury

Spinal Cordvolume 56pages382391 (2018) | Download Citation


Study Design

Experimental prestudy and poststudy.


Examine the acute effects of intermittent negative pressure (INP) applied to the lower limb on foot circulation in people with spinal cord injuries (SCIs).


Vascular laboratory, Oslo University Hospital.


Twenty-four people with SCI (median age 59 years, range 29–74) were exposed to lower leg INP (−40 mm Hg) using an air-tight pressure chamber connected to an INP generator. The contralateral leg was placed outside the pressure chamber. We continuously measured arterial blood flow velocity (ultrasound Doppler), skin blood flow (laser Doppler), skin temperature of the dorsum of the foot, heart rate (ECG) and systemic blood pressure (Finometer) during 5-min baseline (atmospheric pressure), followed by 10-min INP (alternating 10 s −40 mm Hg and 7 s atmospheric pressure), and 5-min post-INP (atmospheric pressure). Skin blood flow was measured on the foot placed outside the pressure chamber. A mixed effects regression model was applied to estimate the effect of INP on blood flow. To quantify flow fluctuations, we calculated cumulative up-and-down changes in arterial blood flow velocity per minute.


Flow fluctuations increased during INP compared to baseline [32.3 cm/s/min (95% CI 26.9 to 37.7) vs. 15.2 cm/s/min (95% CI 9.8 to 20.6), P < 0.001]. Peak blood flow velocity and skin blood flow was reached 2–3 s after the onset of negative pressure and increased 33% (95% CI 16 to 46, P < 0.001) and 11% (95% CI −4.1 to 60, P = 0.14) above baseline, respectively.


INP induced increased foot arterial blood flow fluctuations compared to baseline.


The Norwegian Research Council provided funding to Otivio (grant: 241589).

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The authors would like to thank the patients for their participation in this study. We appreciate Otivio AS for procuring laboratory probes, subatmospheric pressure chambers, and INP pumps for use in the study. We would also like to thank Øystein Horgmo at the Medical Photography Section at the Institute of Clinical Medicine, University of Oslo for help with the illustrations and Annie Bersagel for language editing.

Author contributions

ØHS, LØH, JH, and HW-F conceived of and designed the study. ØHS performed the experiments. ØHS, LØ, JH, HW-F, II, and HH, analyzed the data; ØHS, LØH, JH, and II interpreted the results of the experiments; LØH, ØHS, and JH prepared the figures; ØHS wrote the manuscript. All authors edited and critical reviewed the manuscript and approved the final version of the manuscript.


The Research Council of Norway provided funding to Otivio (NFR grant no: 241589) for this study as part of an industrial PhD project at the Univerity of Oslo.

Author information


  1. Section of Vascular Investigations, Department of Vascular Surgery, Oslo University Hospital, Oslo, Norway

    • Øyvind Heiberg Sundby
    • , Lars Øivind Høiseth
    •  & Jonny Hisdal
  2. Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway

    • Øyvind Heiberg Sundby
    • , Ingebjørg Irgens
    •  & Gunnar Sanbæk
  3. Otivio AS, Gaustadalléen 21, 0349, Oslo, Norway

    • Øyvind Heiberg Sundby
    •  & Iacob Mathiesen
  4. Department of Anesthesiology, Oslo University Hospital, Oslo, Norway

    • Lars Øivind Høiseth
  5. Department of Research, Sunnaas Rehabilitation Hospital, Oslo, Norway

    • Ingebjørg Irgens
    •  & Eivind Lundgaard
  6. Department of Spinal Cord Injury, Sunnaas Rehabilitation Hospital, Oslo, Norway

    • Hanne Haugland
  7. Oslo Center for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway

    • Harald Weedon-Fekjær
  8. Department of Vascular Surgery, Oslo University Hospital, Oslo, Norway

    • Jon O. Sundhagen
  9. Department of Radiology, Oslo University Hospital, Oslo, Norway

    • Gunnar Sanbæk


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Conflict of interest

ØHS is employed at and is a shareholder in Otivio AS. Otivio AS owns and has the commercial rights to the intermittent negative pressure (INP) technology used in the study. IM is the CSO and co-founder of Otivio AS and is a shareholder in the company. None of the other authors have any personal conflicts of interest—financial or otherwise. The authors alone are responsible for the content and writing of the paper. Otivio has not had any role related to the design of the study, collection and analysis of data, or the decision to publish the results.

Ethical approval

The Regional Committee for Medical and Health Research Ethics in Norway approved the experimental protocols (protocol number: 2014/1967). The study was performed in accordance with the Declaration of Helsinki.

Informed consent

Written and oral informed consent was obtained from all participants.

Corresponding author

Correspondence to Øyvind Heiberg Sundby.

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