Hemodynamic Changes at the Saphenofemoral Junction During the Application of a Below-Knee Graduated Compression Stocking

Abstract

It is strongly recommended that patients wear compression after foam sclerotherapy, but pulling up a stocking may inadvertently flush foam into the femoral vein, which may increase the risk of systemic side effects and reduce great saphenous vein (GSV) occlusion rates. The hypothesis was that a stocking pull-up maneuver would increase flow in the GSV. The aim was to quantify this using duplex ultrasound. Twelve consecutive patients with primary varicose veins were studied. A below-knee 23- to 32-mmHg graduated elastic compression stocking was placed over the foot, leaving a cuff of redundant stocking around the ankle. Duplex ultrasound over the saphenofemoral junction was used to measure peak velocity (PV) and volume flow (VF) before and while the stocking was being pulled up. The pull-up maneuver caused a median 17.7 times increase in PV (interquartile range (IQR) 14.2-23.9), from 7.6cm/seconds (IQR 6.4-9.8cm/seconds) to 150.5cm/seconds (IQR 110-187cm/seconds) and a 9.4 times increase in VF (IQR 7.7-10.3), from 50.9 mL/minutes (IQR 33.8-78.9 mL/minutes) to 458.7 mL/minutes (IQR 292.1-593 mL/minutes) (p=.002). A stocking causes significant hemodynamic changes within the GSV. These forces could be avoided by the partial application of a stocking to knee level before foam injection. Further work may establish the implication of these findings in patients treated with foam sclerotherapy.