Effect Of Elastic Compression Stockings Research Articles

Graduated elastic compression stockings in the prevention of post-thrombotic syndrome: A systematic review and meta-analysis.

The effect of graduated elastic compression stockings (ECS) in the prevention of post-thrombotic syndrome (PTS) has been questioned since a large randomized trial found no prophylactic effect of ECS. To assess the effect of the wearing time of ECS on the incidence of post-thrombotic syndrome (PTS) after proximal deep venous thrombosis, we performed a meta-analysis of the incidence of PTS across randomized and observational studies. PubMed, Embase and Cochrane databases were searched until 12 June 2023 for studies on the effect of ECS on PTS. References of eligible studies were also screened in order to identify other potential studies that might have been missed during the search. Four studies comprising a total of 1467 patients met our inclusion criteria for early initiation and consistent use of ECS in patients with acute proximal DVT. ECS significantly reduced the incidence of mild-moderate PTS (OR: 0.48; 95% CI: 0.36-0.63) as well as severe PTS (OR: 0.44; 95% CI: 0.28-0.58).

Characterizing the biomechanical transmission effects of elastic compression stockings on lower limb tissues by using 3D finite element modelling

Studies have primarily simulated the interface pressure and skin surface stress produced by compression textiles or garments with a single pressure level. However, only a few studies have reported the biomechanical transmission behaviors of compression fabrics from the skin to deeper soft tissues of the human body, especially within the context of compression fabrics providing multiple pressure levels. Therefore, to address this limitation, this study developed novel 3D finite element (FE) models to characterize and visualize the interface pressure exerted at the skin surface by elastic compression stockings (ECSs), a type of typical compression textiles, with either low- or high-pressure levels, and to analyze the resulting stress and stress transmission effects within lower limb tissues. The results of the validated FE models indicated that the simulated interface pressure favorably agreed with the measured pressure data. A close relationship existed between the pressure magnitudes and the lower limb surface curvatures, with the highest interface pressure occurring at the anterior and posterior bony regions of the ankle with greater surface curvatures than those of the posterior calf. The internal tissue stress distributions largely varied, which may be one of the potential causes for the inconsistency observed between the claimed pressure doses and those practically delivered inside. Overall, this study serves to improve the understanding of the working mechanisms of the ECS-lower limb system, allowing for improved functional material design and evaluation of the pressure effectiveness of compression textiles and garments used in physiotherapy.

Is it necessary to wear compression stockings and how long should they be worn for preventing post thrombotic syndrome? A meta-analysis of randomized controlled trials

BackgroundPost thrombotic syndrome (PTS) is a serious complication of deep venous thrombosis (DVT). There were always debates on the efficacy of elastic compression stockings (ECS) in prevention for post thrombotic syndrome. ObjectiveTo assess effects of elastic compression stockings and ECS's wearing time on post thrombotic syndrome after diagnosis of deep venous thrombosis. MethodsPubMed, Cochrane Library, Embase, Web of Science were last searched on 23 November 2022 for studies assessing effects of elastic compression stockings or theirs wearing time on post thrombotic syndrome after diagnosis of deep venous thrombosis. Results9 randomized controlled trials were included. Wearing elastic compression stockings was associated with a statistically reduction in the overall post thrombotic syndrome rate (RR 0.73, 95 % CI 0.53 to 1.00; P = 0.05; I2 = 82 %). No significant difference in severe post thrombotic syndrome rate, recurrent deep venous thrombosis rate, and death rate was seen whether wearing elastic compression stockings or not. The pooled effect of studies comparing different wearing time of elastic compression stockings showed no significant difference in post thrombotic syndrome rate, severe and moderate post thrombotic syndrome rate, recurrent deep venous thrombosis syndrome rate and death rate. ConclusionsWearing ECS can reduce the risk of developing PTS after DVT and a wearing time of less than or equal to 1 year is comparable to 2 years wearing. The results support ECS's role as a foundation therapy for preventing PTS.

Changes in Transcutaneous Oxygen Pressure in the Lower Limb Associated with the Use of Elastic Compression Stockings.

Objective: Elastic compression stockings are used to prevent venous thrombosis in postsurgical patients. However, they have been associated with skin complications, such as medical device-related pressure ulcers. This study aimed to assess the effect of elastic compression stockings on the skin tissue status of the lower limbs. Methods: Transcutaneous oxygen pressure (TcPO2) was measured in the anterior tibia and corresponding soft skin of healthy subjects before, during, and after continuous use of elastic stockings for 30 min. Results: Wearing elastic stockings significantly reduced TcPO2 in the skin of the anterior tibia, and removal of the stockings restored TcPO2 values. Both individuals who exercised regularly and men had lower TcPO2 at all measurement points than both individuals who did not exercise and women. Older subjects (50-60 years) had reduced TcPO2 in the sural region than younger ones (20-30 years). Conclusion: The use of elastic compression stockings caused an early decrease of TcPO2 in healthy subjects. Clinical patients were predicted to be at a high risk of wounding.

Compression Stockings for Preventing the Postthrombotic Syndrome in Patients with Deep Vein Thrombosis

ObjectiveWe conducted a systematic review and meta-analysis to address benefits and harms of using elastic compression stockings after lower-extremity deep vein thrombosis. MethodsWe searched 7 electronic databases through January 15, 2015, including randomized controlled trials (RCTs)/quasi-randomized trials reporting on elastic compression stocking efficacy on postthrombotic syndrome incidence, recurrent venous thromboembolism, mortality, and acute pain after deep vein thrombosis. Two reviewers independently screened records, extracted data, assessed risk of bias, and assessed confidence in effect estimates using Grading of Recommendations Assessment, Development, and Evaluation methodology. We applied random-effects meta-analysis models. ResultsWe included 5 RCTs (n = 1418) reporting on postthrombotic syndrome. The hazard ratio (HR) for postthrombotic syndrome with elastic compression stockings was 0.69 (95% confidence interval [CI], 0.47-1.02). We have very low confidence in this estimate due to heterogeneity and inclusion of unblinded studies at high risk of bias. Excluding high risk of bias studies, a single large RCT at low risk of bias provided moderate-quality evidence of no effect on postthrombotic syndrome (HR 1.00; 95% CI, 0.81-1.24). Moderate-quality evidence including all 5 studies suggests no effect of elastic compression stockings on recurrent venous thromboembolism (relative risk [RR] 0.88; 95% CI, 0.63-1.24) or mortality (RR 1.00; 95% CI, 0.73-1.37, 5 studies). Moderate-quality evidence from one large RCT does not suggest effect on acute pain after deep vein thrombosis. ConclusionsThe highest-quality evidence available suggests no effect of elastic compression stockings on postthrombotic syndrome or pain relief, from a single large RCT. However, results for preventing postthrombotic syndrome differ substantially across studies, and future guideline updates should reflect uncertainty about treatment effects. Elastic compression stockings are unlikely to prevent death or recurrent venous thromboembolism.

Synergistic effect of adjustments of elastic stockings to maintain reduction in leg volume after mechanical lymph drainage.

The objective of the present study was to evaluate the effect of elastic compression stockings on volumetric variations of lymphedematous limbs between mechanical lymph drainage sessions. Eleven patients with Grade II leg lymphedema, regardless of etiology, were evaluated in a randomized clinical trial. The ages ranged from 47 to 83 years old with a mean of 62.4 years. Participants were submitted to mechanical lymph drainage (RAGodoy) associated with adjusted and unadjusted knee-high elastic compression stockings (20/30 Venosan). The effect of these stockings on the maintenance of volumetric reductions between sessions of lymph drainage was assessed. In all, 33 evaluations were carried out, 18 of patients using well-adjusted stockings and 15 with badly-adjusted stockings. The differences in volumes were significant (unpaired t-test; P-value < 0.0001). Adjusting the compression provided by elastic stockings according to the size of the leg has a synergistic effect in reducing volume during mechanical lymph drainage.

The Effectiveness Of 30-40 Mm Hg Compression Stockings To Treat Acute Leg Pain Associated With Proximal Deep Vein Thrombosis: Results From The Sox Randomized Controlled Trial

▪ BackgroundAcute deep venous thrombosis (DVT) is associated with leg pain and discomfort. Elastic compression stockings (ECS) have the potential to improve DVT-related leg pain by reducing the diameter of distended veins, increasing venous blood flow and reducing venous hypertension. To date, however, the effect of ECS on DVT-related leg pain has not been studied. In the SOX Trial, a randomized trial of active ECS vs. placebo ECS to prevent the post-thrombotic syndrome, we measured leg pain intensity at baseline and at several time-points during follow-up. ObjectiveIn a secondary, non-prespecified analysis of the SOX Trial, to determine whether active ECS, compared with placebo (sham) stockings, are effective to reduce leg pain associated with acute proximal DVT. MethodsWe did a multicenter (24 centres in Canada and U.S.) randomized placebo controlled trial of active ECS vs. placebo ECS after a first, symptomatic proximal DVT. Active ECS were knee length, 30-40 mm Hg (Class II) graduated ECS. Placebo ECS were manufactured to appear identical to active ECS but lacked therapeutic compression. Study stockings were worn on the DVT-affected leg daily and continued for up to 2 years. Exclusion criteria were >10 days since DVT diagnosis, not planned to be treated with anticoagulants, known peripheral arterial disease or limb phlegmasia, anticipated lifespan < 6 months, inability of patient or caregiver to apply ECS, thrombolysis to treat DVT, geographically inaccessible for follow-up visits or unable to give informed consent. Leg pain intensity was assessed on a 10-point Visual Analog Scale (0, no pain; 10, worst possible pain) via patient self-report at baseline, 14 days, 1 month and 60 days after randomization. We compared mean pain scores at each time point in the active ECS vs. placebo ECS groups using t-tests. We repeated this analysis, restricted to patients who reported daily stockings use at the 1 month visit (the first visit at which frequency of stocking use was assessed). We conducted pre-specified subgroup analyses by age, sex, and extent of DVT. Results are presented as mean difference (95% confidence interval [CI]) in pain intensity score between groups. All statistical tests were 2-sided and significance was set at P<0.05. Results410 patients were randomized to active ECS and 396 to placebo ECS. One and 2 patients, respectively, were found to be ineligible soon after randomization and excluded from the analysis. Mean time from DVT diagnosis to randomization was 4.7 days. Baseline characteristics were similar in the 2 groups (60% male, mean age 55.1 years, highest proximal extent of DVT was iliac or femoral vein in 70% and popliteal vein in 30%, 87% were out-patients). Pain scores diminished over time in both groups. There were no differences between groups in pain scores at any time-point (Table), and no evidence for subgroup interaction by age category, sex or anatomical extent of DVT (not shown). ConclusionsIn a large randomized placebo-controlled trial in patients with symptomatic proximal DVT, leg pain improved at each follow-up visit to a similar degree in patients randomized to active ECS and placebo ECS, and we did not find evidence for benefit of active ECS to reduce pain associated with acute proximal DVT. As our first follow-up assessment was 14 days after DVT, we were unable to evaluate if active ECS had a beneficial or detrimental effect on pain scores during the first 2 weeks after DVT. Disclosures:No relevant conflicts of interest to declare.

Quantified hemodynamics of compression garments

Various forms of compression therapy have been utilized for centuries in the treatment of venous disease, with inelastic bandage systems being used in the more acute treatment of severe venous disease and elastic compression stockings used for long-term management of the disease. However, with the advancement in inelastic adjustable compression wraps, we now have the option to consider long-term management of venous disease with an inelastic system and not just elastic systems. The aim of this study was to compare the hemodynamic effect of elastic compression stockings and inelastic compression wraps on venous disease patients when both products are applied to provide the same level of compression. Utilizing the APG device (ACI Medical, San Marcos, CA, USA), venous volumes, venous filling indexes and ejection fraction measurements were captured on 10 patients with varying degrees of venous disease. Measurements were obtained for each patient at baseline (without compression), with either 30-40 or 20-30 mmHg elastic compression stockings (ECS) and an inelastic compression wrap (ICW) (Juxta-CUREStm by Circaid Medical, San Diego, CA, USA). The compression level of the ECS was measured at the B1 point utilizing a Picopress&reg; [Microlab Elettronica Sas, Roncaglia di Ponte San Nicol&ograve; (PD), Italy] and the ICW was adjusted to provide the exact compression level as the ECS in order to compare the effects of inelasticity versus elasticity independent of compression differences. As expected, the use of compression therapy significantly improved all measures of hemodynamics although it was found that the ICW (average static stiffness 14.3) further improved the measures over ECS (average static stiffness 2.4). Average venous volumes were reduced over baseline with ECS by 19% while ICW showed a reduction of 35%. Average venous filling indexes were reduced with ECS by 25% and 39% with ICW. The ejection fractions for both devices, ECS and ICW, improved an average of 27%. When applying the same compression level, the stiffness associated with ICW can further improve the venous hemodynamics of venous disease patients over ECS. For certain patients, using ICW could prove to be a significant benefit in the management of their disease.

看護師の下肢静脈機能と弾性ストッキングの効果

看護師の下肢静脈機能と弾性ストッキングの効果

Is the wearing of elastic stockings for half a day as effective as wearing them for the entire day?

Background There is good evidence for the use of compression for some clinical indications but little is known about dosimetry in compression. Objective The aim of this work was to evaluate whether or not the use of compression stockings during part of the day would help in the reduction of evening oedema in patients with clinical, epidemiological, anatomical and physiopathological (CEAP) classifications C0 and C1. Methods The effects of elastic compression stockings on volumetric variations during the working day were evaluated for the legs of two men and 18 women (40 legs). The inclusion criterion was classification as C0 (10 legs) or C1 (30 legs) according to the CEAP criteria. Participants used three-quarter-length elastic compression stockings (20-30 mmHg) on three consecutive days for the entire day or only for the morning or they did not use the stockings at all. Volumetry using the water displacement technique was performed in the morning and in the evening. When the patients wore the stockings only during the morning, volumetry was also performed at 13:00 h. Results Significant increases in volume were observed for both legs when stockings were not used compared with the use of stockings in the morning only. After removing the stockings, both legs had significant increases in volume in the afternoon. However, use for half the day was better than not using the stockings at all. Conclusions The use of elastic compression stockings can reduce volumetric variations during working hours, with the use of stockings for the entire day being better than for just half the day.

Effects of elastic compression stockings on wall shear stress in deep and superficial veins of the calf

The purpose of this study was to estimate wall shear stress (WSS) in individual vessels of the venous circulation of the calf and quantify the effects of elastic compression based on change of vessel geometry and velocity waveform. The great saphenous vein and either a peroneal or posterior tibial vein have been imaged in four healthy subjects using magnetic resonance imaging, with and without the presence of a grade 1 medical stocking. Flow through image-based reconstructed geometries was numerically simulated for both a range of steady flow rates and ultrasound-derived transient velocity waveforms, scaled to give a standardized time averaged flow rate. For steady flow, the stocking produced an average percentage increase in mean WSS of approximately 100% in the great saphenous vein across a range of 0.125-1.25 ml/s. The percentage increase in the peroneal/posterior tibial veins varied from 490 to 650% across a range of 0.5-5 ml/s. In addition, application of the stocking eliminated periods of very low or zero flow from the transient waveforms. The average minimum value of WSS in all vessels without the stocking was <0.1 Pa. With the stocking, this was increased to 0.7 Pa in the great saphenous and 0.9 Pa in the peroneal/posterior tibial veins. The pathophysiological effects of these changes are discussed. In conclusion, the flight stocking was effective in raising venous WSS levels in prone subjects, and this effect was much more pronounced in the deep vessels. The stocking also tended to prevent cessation of flow during periods of increased downstream pressure produced by respiration.

Effectiveness of compression stockings to prevent the post-thrombotic syndrome (The SOX Trial and Bio-SOX biomarker substudy): a randomized controlled trial

BackgroundPost thrombotic syndrome (PTS) is a burdensome and costly complication of deep venous thrombosis (DVT) that develops in 20–40% of patients within 1–2 years after symptomatic DVT. Affected patients have chronic leg pain and swelling and may develop ulcers. Venous valve disruption from the thrombus itself or thrombus-associated mediators of inflammation is considered to be a key initiating event for the development of venous hypertension that often underlies PTS. As existing treatments for PTS are extremely limited, strategies that focus on preventing the development of PTS in patients with DVT are more likely to be effective and cost-effective in reducing its burden. Elastic compression stockings (ECS) could be helpful in preventing PTS; however, data on their effectiveness are scarce and conflicting.Methods/DesignThe SOX Trial is a randomized, allocation concealed, double-blind multicenter clinical trial. The objective of the study is to evaluate ECS to prevent PTS. A total of 800 patients with proximal DVT will be randomized to one of 2 treatment groups: ECS or placebo (inactive) stockings worn on the DVT-affected leg daily for 2 years. The primary outcome is the incidence of PTS during follow-up. Secondary outcomes are severity of PTS, venous thromboembolism (VTE) recurrence, death from VTE, quality of life and cost-effectiveness. Outcomes will be evaluated during 6 clinic visits and 2 telephone follow ups. At baseline, 1 and 6 months, blood samples will be obtained to evaluate the role of inflammatory mediators and genetic markers of thrombophilia in the development of PTS (Bio-SOX substudy).DiscussionThe SOX Trial will be the largest study and the first with a placebo control to evaluate the effectiveness of ECS to prevent PTS. It is designed to provide definitive data on the effects of ECS on the occurrence and severity of PTS, as well as DVT recurrence, cost-effectiveness and quality of life. This study will also prospectively evaluate the predictive role of biomarkers that are reflective of putative underlying pathophysiological mechanisms in the development of clinical PTS. As such, our results will impact directly on the care of patients with DVT.Trial RegistrationNCT00143598 and ISRCTN71334751

Role of MRI in investigating the effects of elastic compression stockings on the deformation of the superficial and deep veins in the lower leg

To evaluate the potential of MRI to investigate the mechanical effects of compression stockings on the veins of the lower limb. The right calves of eight healthy volunteers were imaged in the prone position, with and without the presence of a compression stocking. Cross-sectional areas of all peroneal and posterior tibial veins, both saphenous veins, and any sufficiently large superficial veins were segmented in all subjects at mid-calf level in both cases. Variation in cross-sectional area along the axis of the great saphenous vein and a peroneal vein was also examined in three subjects. The mean cross-sectional area reduction was found to be greater in the deep veins (64%) than in the superficial veins (39%). Deep-vein cross-sections were generally elliptical, while superficial veins were approximately circular. Significant axial fluctuations were found in the cross-sectional areas. MRI offers a precise source of data on the mechanical effects of lower-limb compression. Ultrasound (US) may be more cost-effective, but the data acquired are less comprehensive. Future biomechanical studies of lower-limb compression should make use of MRI.

Effect of elastic compression stockings on oedema prevention in healthy controls evaluated by a three‐dimensional measurement system

The degree of oedema may differ at various sites on the leg. This study evaluated the degree of oedema at the calf, ankle and foot using a three-dimensional measurement system. By three-dimensional measurement system using the grid pattern projection method, the effects of four different types of elastic compression stockings on oedema prevention were compared in healthy subjects. Without stockings, a significant increase in the circumference and volume was seen at the ankle and foot in the evening compared with morning values. The average increase in circumference was greater at the foot than that at the ankle. A significant increase in circumference and volume in the evening after a day without stockings disappeared when elastic compression stockings were worn during the day. The coefficient of variation was greater for measurements at the foot than for those at the calf and ankle. Oedema develops easily in order of the foot, the ankle and the calf in healthy populations. Elastic stockings, even with a pressure as low as 8 mmHg, are effective on oedema prevention. In measurement at the foot, further developments are necessary to improve this system.

Compression therapy for treating stage I and II (Widmer) post-thrombotic syndrome.

Post-thrombotic syndrome (PTS) is a long-term complication of deep vein thrombosis characterised by chronic complaints, swelling, and skin changes in the affected limb. One in every three patients with deep vein thrombosis develops post-thrombotic complications within five years. To assess the effectiveness of compression therapy in patients with stage I and II post-thrombotic syndrome according to the classification of Widmer. Interventions of interest included elastic compression stockings and mechanical devices, compared with no intervention and with each other. The reviewers searched the Cochrane Peripheral Vascular Diseases Specialised Trials Register (last searched April 2003), and the Cochrane Central Register of Controlled Trials (CENTRAL) (last searched Issue 1, 2003). In addition, journals, conference proceedings and bibliographies were hand searched. Personal contact with other investigators involved in the clinical area was sought to get information about missed or unpublished studies. Trials that evaluated compression therapy for stage I and II (Widmer) post-thrombotic syndrome. Primary outcomes were leg ulceration, or deterioration of post-thrombotic syndrome. There were no restrictions on date or language. One reviewer (DNK) assessed titles and abstracts for relevance. This was verified independently by a second reviewer (MWCS). Details of eligible studies were extracted and summarised using data extraction sheets. Data extraction was undertaken by one reviewer (DNK) and verified by a second reviewer (MHP). Only two trials were identified that addressed physical treatment of post-thrombotic syndrome. Both trials were initiated by the same group of investigators. A cross-over study lasting two months compared low and high pressure with intermittent compression units for severe post-thrombotic syndrome. This showed a beneficial effect of higher pressures. The second study, in patients with mild to moderate post-thrombotic symptoms, showed no effect of elastic compression stockings (30-40 mm Hg at the ankle region) when compared to 'placebo' stockings that were one to two sizes too large. There is some evidence of a beneficial effect of intermittent pneumatic compression units, but the study was too small and of too short a duration to draw strong conclusions. Further research is needed in order to assess whether intermittent pneumatic compression units give long term reduction and relief of the symptoms caused by post-thrombotic syndrome, and prevent deterioration and leg ulceration. The use of elastic compression stockings to treat post-thrombotic syndrome cannot be supported on the basis of the currently available data.

Effect of elastic compression stockings in patients with varicose veins and healthy controls measured by strain gauge plethysmography.

Oedema is one of the most frequent signs of chronic venous insufficiency and may be present at all stages of this disorder. The aim of this study was to compare the effects of four different types of elastic compression stockings on oedema prevention in patients with varicose veins. An increase in foot volume after elevation of the leg was evaluated by strain gauge plethysmography in 20 limbs with varicose veins and 14 normal limbs, and the effects of four different compression stockings--8, 14, 22 and 30-40 mmHg--were compared. All stockings significantly reduced the foot volume increase compared with the no stockings patient group and the normal group. There was no significant difference in the volume increase in the normal group for all four stockings, while there was a significantly smaller volume increase in the 22 mmHg stocking compared to the 14 mmHg stocking in the patient group. Between the 22 mmHg and 30-40 mmHg stockings or between the 14 mmHg and 8 mmHg stockings, there was no significant difference in the volume increase. Elastic stockings, even with a pressure as low as 8 mmHg, can prevent oedema in patients with varicose veins, as well as in normal controls. However, the 22 mmHg and 30-40 mmHg stockings were better at preventing foot oedema in patients with varicose veins than those exerting less compression.

Perimalleolar subcutaneous tissue pressure effects of elastic compression stockings

Purpose: We hypothesized that the clinical benefit of elastic compression stockings (ECS) is at least in part due to an increase in subcutaneous pressure that may promote resorption of extracellular fluids, providing more efficient diffusion of oxygen and nutrients from the microcirculation to the skin and subcutaneous tissues.Methods: To test this hypothesis we designed and standardized a device for measuring subcutaneous pressure in patients. We then measured the supine perimalleolar subcutaneous pressure from a single limb in four groups: group 1 consisted of control subjects (n = 8); group 2 consisted of patients with varicose veins and superficial venous insufficiency without lipodermatosclerosis or edema (n = 5); group 3 consisted of patients with deep venous insufficiency and lipodermatosclerosis but without edema (n = 8); and group 4 consisted of patients with deep venous insufficiency, lipodermatosclerosis, and clinically evident edema (n = 8). Measurements were made at baseline and after application of 20 to 30 mm Hg and 30 to 40 mm Hg ECS.Results: There was no significant difference in the baseline subcutaneous pressure between the three groups without clinical edema (p > 0.05). Baseline perimalleolar pressure was elevated, however, in group 4 patients compared with groups 1, 2, and 3 (p < 0.05). All three groups with chronic venous insufficiency (CVI) (groups 2, 3, 4) demonstrated increases in subcutaneous pressure with application of ECS, which was statistically significant in groups 3 and 4. There was no difference between the increase in perimalleolar subcutaneous pressure induced by 20 to 30 mm Hg or 30 to 40 mm Hg ECS in groups 3 and 4.Conclusions: Patients with CVI and edema have significant elevations in supine resting perimalleolar subcutaneous pressure compared with control subjects and patients with CVI without edema. Twenty to 30 mm Hg and 30 to 40 mm Hg ECS increased measured perimalleolar subcutaneous pressure in patients with CVI with and without clinical edema but not in control patients. These results suggest the mechanism of benefit of ECS in patients with CVI is due at least in part to an increase in subcutaneous pressure that may act to promote more efficient absorption of perimalleolar extracellular fluid.

Perimalleolar subcutaneous tissue pressure effects of elastic compression stockings

We hypothesized that the clinical benefit of elastic compression stockings (ECS) is at least in part due to an increase in subcutaneous pressure that may promote resorption of extracellular fluids, providing more efficient diffusion of oxygen and nutrients from the microcirculation to the skin and subcutaneous tissues. To test this hypothesis we designed and standardized a device for measuring subcutaneous pressure in patients. We then measured the supine perimalleolar subcutaneous pressure from a single limb in four groups: group 1 consisted of control subjects (n = 8); group 2 consisted of patients with varicose veins and superficial venous insufficiency without lipodermatosclerosis or edema (n = 5); group 3 consisted of patients with deep venous insufficiency and lipodermatosclerosis but without edema (n = 8); and group 4 consisted of patients with deep venous insufficiency, lipodermatosclerosis, and clinically evident edema (n = 8). Measurements were made at baseline and after application of 20 to 30 mm Hg and 30 to 40 mm Hg ECS. There was no significant difference in the baseline subcutaneous pressure between the three groups without clinical edema (p > 0.05). Baseline perimalleolar pressure was elevated, however, in group 4 patients compared with groups 1, 2, and 3 (p < 0.05). All three groups with chronic venous insufficiency (CVI) (groups 2, 3, 4) demonstrated increases in subcutaneous pressure with application of ECS, which was statistically significant in groups 3 and 4. There was no difference between the increase in perimalleolar subcutaneous pressure induced by 20 to 30 mm Hg or 30 to 40 mm Hg ECS in groups 3 and 4. Patients with CVI and edema have significant elevations in supine resting perimalleolar subcutaneous pressure compared with control subjects and patients with CVI without edema. Twenty to 30 mm Hg and 30 to 40 mm Hg ECS increased measured perimalleolar subcutaneous pressure in patients with CVI with and without clinical edema but not in control patients. These results suggest the mechanism of benefit of ECS in patients with CVI is due at least in part to an increase in subcutaneous pressure that may act to promote more efficient absorption of perimalleolar extracellular fluid.

Effect of elastic compression stockings on venous hemodynamics in hemiplegic patients

Unilateral lower extremity edema and an increased risk of thromboembolism have been associated with hemiplegia following stroke. This study was undertaken to determine the effect of knee-high, graded elastic stockings on venous hemodynamics in hemiplegic patients. Thirty-six patients with recent cerebral infarcts were studied. The presence of underlying venous or arterial occlusive disease was excluded in all patients. Duplex scanning techniques were used to measure femoral and popliteal venous circumference, cross-sectional area, and peak flow velocity in the normal and paralyzed extremities both with and without stockings. All patients were examined and assessed for the degree of motor weakness and Brunnstrom stage of recovery. Associated medical illnesses were also reviewed. These patients were found to have a decreased flow in the femoral (p = 0.0002) and popliteal (p = 0.006) veins and an increase in the femoral vein size. The application of compression stockings resulted in a significant increase in venous size and flow velocity in both areas. The femoral and popliteal velocity correlated inversely with the degree of motor impairment and Brunnstrom stage, suggesting that factors other than the muscle pump may be responsible for the augmentation of femoral flow velocity in the paralyzed leg. There was no correlation demonstrated with other variables such as age, gender, cardiovascular disease, or diabetes. These results would indicate a potential benefit of graded knee-high elastic compression stockings in reducing venous flow stasis in hemi-paretic patients.

The influence of elastic compression stockings on deep venous hemodynamics

To determine the effect of elastic compression stockings on deep venous hemodynamics we measured ambulatory venous pressure, venous refill time, maximum venous pressure with exercise, amplitude of venous pressure excursion, and duplex-derived common femoral and popliteal vein diameter and peak flow velocities with and without stockings in 10 healthy subjects and 16 patients with chronic deep venous insufficiency. The effects of below-knee and above-knee 30 to 40 torr and 40 to 50 torr gradient stockings were studied. Despite documentation of substantial stocking compressive effects by skin pressure measurements, neither below-knee or above-knee elastic compression stockings significantly improved ambulatory venous pressure, venous refill time, maximum venous pressure with exercise, or the amplitude of venous pressure excursion in healthy patients or in patients with deep venous insufficiency (p greater than 0.05). In patients with deep venous insufficiency stockings modestly increased popliteal vein diameter and flow velocity in the upright resting position (p less than 0.02). After tiptoe exercise without stockings deep venous peak flow velocity increased in healthy patients and in patients with deep venous insufficiency by a mean of 103% in the popliteal vein and 46% in the common femoral vein (p less than 0.01). With the application of elastic compression stockings only modest augmentation of deep venous flow velocity occurred in both groups above that seen in the bare leg after exercise. Thus elastic compression stockings did not improve deep venous hemodynamic measurements in patients with deep venous insufficiency. The beneficial effects of stockings in the treatment of deep venous insufficiency must relate to effects other than changes in deep venous hemodynamics.