During muscle contraction (systole), the muscles exert high pressure on the deep venous system and milk the blood toward the proximal veins. Two major pumps propel the blood centrally: the cardiac pump and the muscle pump. The blood flows from the superficial to the deep system through perforating veins upward toward the heart valves impede reflux. 1 The venous system in the lower extremities is composed of a superficial venous system, a deep venous system within fascia, and a connecting perforating system. Clinical BackgroundĬhronic venous insufficiency (CVI) of the lower extremities is a condition caused by abnormalities of the venous wall and valves, leading to obstruction or reflux of blood flow in the veins. This memorandum serves four purposes: (1) outlines the description and treatment of chronic venous insufficiency (2) reviews the history of Medicare's national coverage policies for pneumatic compression pumps for the treatment of generalized refractory edema from venous insufficiency (3) presents and analyzes the relevant clinical and scientific data related to the use of pneumatic compression pumps for venous insufficiency, and (4) delineates the rationale for our decision not to make any changes to this portion of the national coverage determination. Medical Officer, Division of Items and Devices Policy Analyst, Division of Items and Devices Pneumatic Compression Devices for the treatment of generalized, refractory edema from venous insufficiency
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