Green Cross Medico are delighted to be a finalist in the Scottish Knowledge Exchange Awards 2024.

We have collaborated with Edinburgh Napier University along with Professor Philip Stather, Consultant Vascular and Endovascular Surgeon, Norfolk and Norwich University Hospital, to re-develop the 2nd generation of Airglove for both cannulation and Peripheral Arterial Disease (PAD). The new Airglove Leg innovation includes a cradle to house the Airglove unit and footrest for the patient.

Peripheral arterial disease (PAD) is a disabling condition which effects over 200 million people worldwide. This is a common condition where a build up of fatty deposits in the arteries restricts the blood supply to the leg muscles. Predominant symptoms are of muscle cramping or pain on exertion, commonly effecting the calf muscles which can substantially reduce quality of life. This is termed intermittent claudication (IC). As the disease progresses it can lead to pain at rest, ulceration and gangrene, termed critical limb ischaemia (CLI). CLI requires urgent revascularisation, however not all patients are fit to undergo intervention, or have progressed beyond limb salvage. Therefore, a significant proportion of patients undergo either amputation or palliation. CLI has a mortality rate as high as 20% within 6 months from diagnosis.

Data taken from the UK National Vascular Registry identified over 3500 major lower limb amputations per year primarily due to diabetes and peripheral arterial disease, with over 18000 lower limb bypass procedures as well as approximately 4 times as many angioplasties undertaken in the UK alone. Amputation as well as surgical bypass or angioplasty can often be avoided by earlier intervention, behavioural modification and education.

The first treatment for patients with PAD is to try to improve the collateral circulation naturally. NICE guidelines recommend two aspects of conservative therapy, namely secondary prevention of cardiovascular disease, and supervised exercise therapy (SET). All patients with intermittent claudication should be entered into a SET programme consisting of 2 hours of supervised exercise per week for a 3-month period, encouraging patients to exercise to the point of maximal pain. Unfortunately, the provision of supervised exercise is somewhat lacking. Less than 40% of hospitals in the UK provide a supervised exercise programme, with less than 10% of all patients attending exercise classes. SET is also not possible for many patients especially those with walking difficulties limiting their ability to exercise or walk sufficiently to improve their circulation.

Airglove Leg is a heat therapy limb warming device which can induce vasodilation by increasing blood flow.  It does this by circulating the air at 3 set temperatures for up to 20 mins per cycle between the inner and outer layers of the leg glove, with no air coming into contact with the patient. Airglove Arm is currently in use in over 140 NHS hospitals to aid with peripheral cannulation in patients with difficult vascular access (DIVA). As this medical device is already in clinical use, modifying the device for use in PAD has potential benefits for this cohort of patients. Heat therapy for PAD has significant advantages of being a home-based programme as it is cost effective, and suitable for all patients regardless of mobility or comorbidities, plus has the potential to save legs reducing surgical intervention.