Palabras clave
Cómo citar
Resumen
El edema en las extremidades inferiores es una manifestación frecuente en personas con insuficiencia cardíaca congestiva, especialmente en aquellos con disfunción del ventrículo derecho. Aunque la terapia compresiva es el tratamiento de elección en el manejo del edema y linfedema en extremidades inferiores, su aplicación en pacientes con insuficiencia cardiaca sigue siendo motivo de controversia debido al modelo teórico de riesgo de sobrecarga circulatoria.
La evidencia científica que respalda esta precaución es limitada. No obstante, estudios recientes sugieren que la compresión controlada, aplicada con criterios clínicos adecuados, podría ser segura y eficaz en pacientes seleccionados con insuficiencia cardiaca en estadios funcionales NYHA I, II o III, sin provocar deterioro hemodinámico significativo.
Esta revisión narrativa analiza el estado actual del conocimiento sobre las indicaciones, precauciones y eficacia clínica de la terapia compresiva en pacientes con insuficiencia cardiaca congestiva, así como los distintos tipos de compresión utilizados. Además, se destacan las principales brechas de conocimiento y se plantea la necesidad de investigaciones más robustas que orienten la práctica en el abordaje del edema de extremidades inferiores de estos pacientes.
Citas
Abassi Z, Khoury EE, Karram T, Aronson D. Edema formation in congestive heart failure and the underlying mechanisms. Frontiers in Cardiovascular Medicine [Internet]. 2022;9(933215). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9553007/
Al-Dorzi HM, Al-Dawood A, Al-Hameed FM, et al. The effect of intermittent pneumatic compression on deep-vein thrombosis and ventilation-free days in critically ill patients with heart failure. Sci Rep. 2022;12(1):8519. doi: 10.1038/s41598-022-12336-9. Available from: https://pubmed.ncbi.nlm.nih.gov/35595804/
Andriessen A, Apelqvist J, Mosti G, et al. Compression therapy for venous leg ulcers: risk factors for adverse events and complications, contraindications - a review of present guidelines. J Eur Acad Dermatol Venereol. 2017;31(9):1562-1568. doi: 10.1111/jdv.14390. Epub 2017 Jul 31. Available from: https://pubmed.ncbi.nlm.nih.gov/28602045/
Anguita Sánchez M, Bonilla Palomas JL, García Márquez M, et al. (2020). Temporal trends in hospitalizations and in-hospital mortality in heart failure in Spain 2003–2015: differences between autonomous communities. Revista Española de Cardiología (English Edition), 2020; 73(12): 1075–77. Available from: https://doi.org/10.1016/j.rec.2020.05.040
Atkin L, Byrom R. The links between heart failure and leg oedema: the importance of compression therapy.Wounds UK. 2022; 18(3). Available from:: https://wounds-uk.com/journal-articles/links-between-heart-failure-and-leg-oedema-importance-compression-therapy/
Attaran RR, Cavanaugh A, Tsay C, et al. Safety of compression therapy for venous ulcer disease in the setting of congestive heart failure. Phlebology. 2020;35(8):556-560. doi: 10.1177/0268355520905178.
Augey F, Pinet A, Renaudier P. Insuffisance cardiaque et ulcère de stase : une association significative (étude prospective de 100 cas). 2010. Annales de dermatologie et de venereologie.; 137 (5): 353-5. [citado 2025 Jun 19]. doi:10.1016/j.annder.2010.03.022
Civera J, Miñana G, de la Espriella R, et al. Venous Leg Compression for Tissue Decongestion in Patients With Worsening Congestive Heart Failure. Front Cardiovasc Med. 2022; 9:847450. doi: 10.3389/fcvm.2022.847450.
Conde-Montero E, Dissemond J, Protz K. [Translated article] Compression Therapy in Dermatology. Actas Dermosifiliogr. 2024;115(7):T693-T701. doi: 10.1016/j.ad.2024.05.012. Epub 2024 May 29.
Cooper-Stanton G. Compression therapy and heart failure: a scoping review of the existing evidence. Br J Community Nurs. 2022;27(3):128-134. doi: 10.12968/bjcn.2022.27.3.128.
Dissemond J, Protz K, Stücker M. Compression therapy in dermatology. JDDG: Journal der Deutschen Dermatologischen Gesellschaft. 2023; 21: 1003-19. Available from: https://doi.org/10.1111/ddg.15161
Fadel RA, Cerna Viacava R, Makki T, et al. Compression wraps as adjuvant therapy in the management of acute systolic heart failure. Heliyon. 2023;9(8): e19008. doi:10.1016/j.heliyon.2023.e19008.
Gonzalez Rodriguez B, Calderón Lozano L, Fulgencio Barbarin J, Conde Montero E. Compression Therapy in Leg Ulcers Due to Increased Diffusion Space [Internet]. Actasdermo.org. 2025. Available from: https://www.actasdermo.org/espdfS0001731025000614
Grupo de Trabajo de la Guía de pràctica clínica sobre tratamiento de la insuficiència cardíaca. RedETS sanidad global: Ministerio de sanidad, Servicios sociales e igualdad, Unidad de evaluació de tecnologías sanitarias de la comunidad de Madrid. 214p. Informe: 680-17-031-3. Available from: https://redets.sanidad.gob.es/documentos/GPC_2016_IC.pdf
Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2022;79(17):263–421. Available from: https://doi.org/10.1161/cir.0000000000001062
Levick JR, Michel CC. Microvascular fluid exchange and the revised Starling principle [Internet] Cardiovascular Research. 2010;87(2):198–210. Available from: https://pubmed.ncbi.nlm.nih.gov/20200043/
McDonagh TA, Metra M, Adamo M, Gardner RS, et al. Guía ESC 2021 sobre el diagnóstico y tratamiento de la insuficiencia cardiaca aguda y crònica [internet]. Revista Española de Cardiología. 2022;75(6):458-465 . Disponible en: https://www.revespcardiol.org/es-guia-esc-2021-sobre-el-articulo-S0300893221005236
Mosti G, Iabichella ML, Partsch H. Compression therapy in mixed ulcers increases venous output and arterial perfusion. J Vasc Surg. 2012; 55(1):122-8. doi: 10.1016/j.jvs.2011.07.071. Epub 2011 Sep 23. Available from: https://pubmed.ncbi.nlm.nih.gov/21944912/
Mosti G, Partsch H. Inelastic bandages maintain their hemodynamic effectiveness over time despite significant pressure los [internet]. National Library of Medicine: J Vasc Surg. 2010; 52 (4): 925-31. Available from: https://pubmed.ncbi.nlm.nih.gov/20620002/
Nasu T, Matsumoto S, Fujimoto W, Numazaki H, Morino Y. The safety and efficacy of compression therapy in patients with stable heart failure. Int J Cardiol Heart Vasc. 2024; 50:101343. doi: 10.1016/j.ijcha.2024.101343. Disponible en: https://pubmed.ncbi.nlm.nih.gov/38304726/
NICE guideline. Chronic Heart Failure in adults: Diagnosis and Management [internet]| Guidance | NICE [Internet]. Nice.org.uk. National Institute for Health and Care Excellence; 2018. Disponible en: https://www.nice.org.uk/guidance/ng106
Nose Y, Murata K, Wada Y, Tanaka T, Fukagawa Y, Yoshino H, Susa T, Kihara C, Matsuzaki M. The impact of intermittent pneumatic compression devices on deep venous flow velocity in patients with congestive heart failure. J Cardiol. 2010;55(3):384-90. doi: 10.1016/j.jjcc.2010.01.002. Epub 2010 Feb 6.
Rabe E, Partsch H, Morrison N, et al. Risks and contraindications of medical compression treatment - A critical reappraisal. An international consensus statement. Phlebology. 2020;35(7):447-60. doi: 10.1177/0268355520909066. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7383414/
Ringley CD, Johanning JM, Gruenberg JC, Veverka TJ, Barber KR. Evaluation of pulmonary arterial catheter parameters utilizing intermittent pneumatic compression boots in congestive heart failure. Am Surg. 2002; 68(3):286-9. Available from: Evaluation of pulmonary arterial catheter parameters utilizing intermittent pneumatic compression boots in congestive heart failure - PubMed.
Saucedo D, Evans N, Lim CS. Initiating compression therapy for those living with heart failure. Br J Community Nurs. 2021;26(Sup9):S12-S17. doi: 10.12968/bjcn.2021.26.Sup9.S12. Disponible en: https://pubmed.ncbi.nlm.nih.gov/34473543/
Shaphiro J. Podiatry managment. Can we compress the legs of patients with CHF. Podiatry management; 2020: 33-6. Disponible en: https://podiatrym.com/pdf/2020/10/Shapiro1120web.pdf
Smith B, Park J, Landi JL, McConnell B, Rahman A, Omari AR, Shahab Z, Carilli A, Pearl K, Kim B, Costin JM. Chronic Edema Management of the Lower Extremities. Cureus. 2024 Jul 4;16(7):e63840. doi: 10.7759/cureus.63840.
Urbanek T, Juśko M, Kuczmik WB. Compression Therapy for Leg Oedema in Patients with Heart Failure [internet]. ESC Heart Failure. 2020; 7: 2012-20. Available from: https://doi.org/10.1002/ehf2.12848
Wounds UK (2023) Best Practice Statement: The use of compression therapy for peripheral oedema: considerations in people with heart failure. Wounds UK, London. Available from: www.wounds-uk.com
Esta obra está bajo licencia internacional Creative Commons Reconocimiento-NoComercial-SinObrasDerivadas 4.0.