Response to “Re. Lower Limb Deep Vein Diameters Beneath Medical Compression Stockings in the Standing Position”

Abstract

We are pleased to see that our work is a source of scientific debate around the effect of compression therapy in vascular disorders, and we agree that the mechanisms of such therapy should be considered as more complex than they appear. Initially, our work did not aim to oppose the paradox hypothesis.1Rastel D. Lun B. Lower limb deep vein diameters beneath medical compression stockings in the standing position.Eur J Vasc Endovasc Surg. 2019; 57: 276-282Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar We designed our experimental trial to document an assumption based, on the one hand, on impressive magnetic resonance imaging (MRI) images of a single selected case report, and, on the other, on limited numerical data.2Partsch H. Mosti G. Mosti F. Narrowing of leg veins under compression demonstrated by magnetic resonance imaging (MRI).Int Angiol. 2010; 29: 408-410PubMed Google Scholar, 3Uhl J.F. Benigni J.P. Cornu-Thenard A. Fournier J. Blin E. Relationship between medical compression and intramuscular pressure as an explanation of a compression paradox.Phlebology. 2015; 30: 331-338Crossref PubMed Scopus (17) Google Scholar Nevertheless, our results demonstrated not only that muscle contraction was predominantly responsible for reducing vein diameters in the standing position, but also that medical compression stockings did not add any significant synergistic effect. We acknowledge that the muscle contraction effect on deep vein diameters has a wide range of results. This can be easily explained by the high variability in patient leg morphology and the legs’ ability to contract. This assumption is supported by consistent results observed within an extended range of applied pressure on patients involved in this medical compression trial. Moreover, as reported by Uhl,4Uhl J.F. 3D multislice CT to demonstrate the effects of compression therapy.Int Angiol. 2010; 29: 411-415PubMed Google Scholar the acquisition time during radiology imaging is long, and consequently patients in the standing position must contract their muscles more or less to maintain body balance, unless suspended which was not the case in Uhl's study. Consequently in compression therapy, when investigating the diameter of deep veins of patients in the standing position, unless it is absolutely certain that the calf muscles are not at all contracted during MRI acquisition, the observed phenomena are not related to the external compression exerted by medical compression stockings. As reported recently,5Frauziols F. Chassagne F. Badel P. Navarro L. Molimard J. Curt N. et al.In vivo identification of the passive mechanical properties of deep soft tissues in the human leg.Strain. 2016; 52: 400-411Crossref Scopus (13) Google Scholar we support the statement recommending that “the compartment pressure surrounding the deep veins has to be taken into account” for future investigations. Paradox Findings are Reality, Difficult is the ExplanationEuropean Journal of Vascular and Endovascular SurgeryVol. 57Issue 6PreviewIn their article “Lower limb deep vein diameters beneath medical compression stockings in the standing position”, Rastel et al. concluded that in the standing position, deep vein diameter reduction is not caused by medical compression stockings (MCSs) but may be due to the isometric muscle contractions.1 There is some doubt if this simple message is the full truth, as we would expect to see the effect regularly, even without any compression, which is not the case. Quite the opposite: the diameter of deep veins is usually larger without compression in the standing vs. Full-Text PDF Open Archive