Progressive or degressive compression pressure profile in patients with chronic venous disorders of the lower limb

Abstract

Graduated compression devices are considered the standard care for management of venous and lymphatic disorders. Recently compression devices exerting a pressure over the calf higher than over the ankle have been proved to be more effective than traditional graduated devices in increasing the impaired ejection fraction (EF) from the lower leg in patients with venous disease. Aim of this work is presenting an overview of the new concept on progressive compression, its potential benefits and limits. In different series of tests, the EF from the lower leg was assessed in 70 patients with severe reflux in the great saphenous vein (GSV). EF was measured by strain gauge plethysmography, in baseline conditions and after applying graduated compression devices or the new inversely graduated or progressive compression (PC) devices. The interface pressure was recorded, simultaneously with the EF, both in the gaiter area (B1 point) and at the calf (C point) in order to assess the compression pressure profile. EF, severely impaired in patients with GSV reflux, was increased by compression. So called PC devices (both PC elastic stocking and PC inelastic bandages) were significantly more effective than graduated compression in increasing the ejection fraction. The higher the pressure on the calf the higher the EF improvement. Maintaining the same strong pressure over the calf by means of two progressive stockings and increasing the pressure only over the calf to restore a graduated compression didn’t improve the EF. To improve venous pumping function in the ambulant patient stronger compression of the calf is more effective than graduated compression. This can be explained by the higher amount of blood volume pooled in the calf veins.