Elastic Compression Stockings Research Articles

RANDOMIZED CLINICAL TRIAL OF ASPIRIN AS PROPHYLAXIS FOR THROMBOEMBOLISM IN HIP ARTHROPLASTY.

This study aims to evaluate aspirin as a chemical prophylaxis (200 mg) in total hip arthroplasty. the study compared two groups and used ultrasonography (USG) to screen for low-deep venous thrombosis. Group 1 received 600 mg (control), and Group 2 received 200 mg of (intervention), associated with the use of elastic compression stockings and early walking. fourteen patients were allocated to Group A (200mg), and 16 to Group B (600mg); in group A (200mg), 3 cases with thrombus below the popliteal vein were detected at the first USG examination. All of them are in the left lower limb (21.4%). In group B (600 mg), 5 cases were identified after the first exam (31.2%). All cases were asymptomatic and followed the protocol with prophylaxis only with Aspirin. In the statistical data, there were no differences in the presence of thrombus between the 200- and 600 mg groups, which is credited to using low-dose aspirin in low doses (200mg). Hematimetric levels returned to baseline levels and suggested there was no chronic or acute bleeding related to the use of aspirin. The manuscript was prepared according to the CONSORT guideline 2010. Level of Evidence I; Longitudinal Randomized Comparative Clinical Study.

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).

A randomized controlled trial of standard vs customized graduated elastic compression stockings in patients with chronic venous disease

ObjectiveThis study aimed to compare the efficacy of customized graduated elastic compression stockings (c-GECSs) based on lower leg parameter models with standard GECSs (s-GECSs) in patients with chronic venous disease (CVD). MethodsIn this randomized, single-blind, controlled trial, 79 patients with stage C2 or C3 CVD were assigned to one of two groups: c-GECSs or s-GECSs. The primary outcome was change to Venous Insufficiency Epidemiological and Economic Study Quality of Life (VEINES-QOL) scores at months 1, 3, and 6 as compared with baseline. Secondary outcomes included compliance with wearing ECSs, interface pressure at the smallest circumference of the ankle (point B) and the largest circumference of the calf (point C), and calf volume (CV). ResultsThere were 13 pairs of s-GECS and 2 pairs of c-GECS that showed pressure values higher than the standard at either point B or C. The c-GECSs were significantly superior to s-GECSs in terms of score improvement at all three time points (month 1, 8.47 [95% confidence interval (CI), 7.47-9.45] vs 5.89 [95% CI, 5.00-6.78]; month 3, 9.60 [95% CI, 8.47-10.72] vs 6.72 [95% CI, 5.62-7.83]; month 6, 7.09 [95% CI, 5.93-8.24] vs 3.92 [95% CI, 2.67-5.18]; P < .0001). Besides, at month 1, the mean daily use time of the c-GECS and s-GECS groups was 10.7 and 9.5 hours, respectively (P < .05). Correlation analysis indicated a negative relationship between local high pressure and daily duration in the s-GECS group (rpb = –0.388; n = 38; P < .05). Variances in pressure were greater in the s-GECSs group. The c-GECSs showed advantage in maintaining pressure. Both c-GECSs and s-GECSs effectively reduced CV (mL), with no significant differences between groups (month 1, 90.0 [95% CI, 71.4-108.5] vs 85.0 [95% CI, 65.6-104.2]; month 3, 93.8 [95% CI, 69.7-117.8] vs 85.9 [95% CI, 65.5-106.2]; month 6, 70.8 [95% CI, 46.5-95.2]) vs 60.8 [95% CI, 44.1-77.5]). ConclusionsThe c-GECSs based on individual leg parameter models significantly improved VEINES-QOL scores and provided stable and enduring pressure as compared with s-GECSs for patients with stage C2 or C3 CVD. Although both c-GECSs and s-GECSs effectively reduced CV, the superior fit and comfort of c-GECSs improved patient compliance. Hence, c-GECSs are a viable alternative for patients who have difficulty tolerating s-GECSs.

Current challenges in the prevention and management of post-thrombotic syndrome-towards improved prevention.

Post-thrombotic syndrome (PTS) is a common and potentially debilitating complication of deep vein thrombosis (DVT), affecting up to 50% of DVT patients. The consequence of this chronic condition includes reduced quality of life, increased use of the healthcare system and decreased productivity. The societal impact of this condition is projected to increase, given our ageing population and increased burden of thrombotic diseases. Despite significant recent advances in our understanding of PTS, many unanswered questions remain. Currently, there are few effective and proven options for established PTS; hence, the emphasis should be on instituting effective prevention to reduce the progression to PTS. Effective anticoagulation lowers the risk of PTS, with direct oral anticoagulants appearing to outperform vitamin-K antagonists. However, the evidence for elastic compression stockings and endovascular thrombolysis or thrombectomy techniques remains unclear. Accurate identification of individuals at high risk of developing PTS may also improve the targeting of preventative interventions. This review will examine the current body of evidence regarding PTS, with a focus on preventative strategies as well as novel biomarkers.

Post-thrombotic syndrome and chronic thromboembolic pulmonary hypertension: diagnosis and management.

Post-thrombotic syndrome and chronic thromboembolic pulmonary hypertension are two distinct clinical syndromes associated with adverse patient outcomes following a venous thromboembolism. Clinical manifestations of post-thrombotic syndrome include persistent pain, swelling and ultimately venous ulceration following a deep venous thrombosis. Patients experiencing chronic thromboembolic pulmonary hypertension may have symptoms ranging from exertional dyspnoea to overt right heart failure. From a physician's perspective, the most effective preventative strategy is good quality anticoagulation for prophylaxis of primary and secondary venous thromboembolism. The treatment of post-thrombotic syndrome mainly involves lifestyle modifications alongside the use of elastic compression stockings while patients with chronic thromboembolic pulmonary hypertension should be offered targeted surgical and medical treatment options available at expert centres. Further research is warranted for both conditions to determine the role of direct oral anticoagulants when used with a preventive or therapeutic intent.

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.

Budget Impact of Three Improvement Targets for Compression Therapy for Patients with Deep Venous Thrombosis in The Netherlands.

Compression therapy following deep venous thrombosis in the Netherlands is suboptimal. We assessed the budget impact of targeted care improvements. We calculated the per-patient and population healthcare resource use and costs concerning 26,500 new patients each year in the Netherlands for the current pathways in region North Holland (divided into two parts: NH-A and NH-B) and region Limburg. Next, we assessed the impact of three improvement targets: optimizing initial compression therapy, early consultation of an occupational therapist, and tailored duration of elastic compression stocking therapy. Inputs were based on interview (n = 30) and survey data (n = 114), literature, and standard prices. The robustness of the results was tested by sensitivity analyses. The current per-patient costs for a 2-year episode were €1046 (NH-A), €947 (NH-B), and €1256 (Limburg). The improvements led to direct savings for region Limburg (€4.7 million). Population costs increased in the first year for NH-A (+ €3.5 million) and NH-B (+ €6.4 million), and decreased in the second and third year resulting in a cost reduction for NH-A (- €2.2 million) but not for NH-B (+ €0.6 million). Workload for occupational therapists and internists in North Holland increased, and workload for home care nurses decreased in all regions. This study provides a detailed insight into current costs and healthcare resource use associated with compression therapy and the potential impact of implementing three improvement targets. We showed that the improvements resulted in considerable cost savings within 3 years after implementation for region NH-A and Limburg.

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.

Effect of Elastic Compression Stocking and Kinesio Taping during Heel-raise Exercise on Muscle Activity, Mechanical Properties, and Muscle Fatigue in Healthy Women

Effect of Elastic Compression Stocking and Kinesio Taping during Heel-raise Exercise on Muscle Activity, Mechanical Properties, and Muscle Fatigue in Healthy Women

Influence of compression therapy following varicose vein surgery: a prospective randomized study.

The use of compression dressings after phlebectomy is based solely on clinical experience due to the lack of a unified set of definitive recommendations, which makes clinical practice extremely heterogeneous. To evaluate compression therapy with elastic stockings for 7 days after phlebectomy. We randomly allocated 104 lower limbs with disease classified as C1 and C2 to 1 of 2 groups: an intervention group (64 limbs) - wearing elastic compression stockings for the first 7 days after phlebectomy; or a control group (40 limbs) - given conventional bandaging for 24 hours postoperatively. We compared clinical response by analyzing the evolution of symptoms, hematoma formation, and preoperative vs. postoperative limb volume. Pain (median 1.0 vs. 1.5, p=0.0320) and limb volume (mean 43.7 vs. 99.8, p=0.0071) were significantly improved in patients wearing elastic compression stockings for 7 days after phlebectomy compared with controls. Use of elastic compression therapy for 7 days after phlebectomy was effective for improving pain and lower limb volume.

The Impact of Obesity and Patient-Reported Reasons on Patient Noncompliance with Compression Stockings

Introduction: The aim of this study is to investigate the impact of obesity on patient compliance with elastic compression stockings and to reveal patient behavior-related and compression stockings-related factors for noncompliance. Patients and Methods: Between July and August 2022, a total of 246 patients with chronic venous insufficiency were included in the study. The patients were divided into two groups, obese and non-obese patients (88 vs. 158 patients), and questioned for proper use of compression stockings and the patient-reported reasons for the non-compliance. Results: The mean age was 49.0 ± 13.1, and the mean BMI was 28.6 ± 5.2. Only 51 patients (20.7%) out of 246 complied with stocking use. The mean number of days per week in which the compression stockings were properly used was 2.9 ± 1.7 in the study population. Patient compliance was higher in the non-obese group (12.5% vs. 25.3%, p= 0.017), and the number of days per week in which the compression stockings were worn properly was higher in the non-obese group (2.6 ± 1.3 vs. 3.1 ± 1.9, p= 0.032). Conclusion: The compliance of our patients with elastic compression stockings was found to be as low as 20.7%. Compliance was lower in the group of obese patients. Obesity and diabetes mellitus were the only factors associated with noncompliance in univariate logistic regression analysis. Further studies are needed in larger patient populations to increase the rate of patient compliance.

Prevalence and Associated Factors of Post-Thrombotic Syndrome in Patients With Deep Vein Thrombosis

Background: Post-thrombotic syndrome (PTS) occurs as a long-term complication of deep vein thrombosis (DVT). The aim of this study was to evaluate the prevalence of PTS and its associated factors in a cohort of patients with lower extremity DVT in Sri Lanka. Methods: A descriptive cross-sectional study was conducted in 80 patients who were assessed 6 months to 2 years after the acute episode of DVT. They were assessed using Vilalta scale to diagnose and grade the severity of PTS, anthropometry to calculate body mass index (BMI), duplex ultrasound scans, patients’ clinic record including international normalized ratio (INR) charts and an interviewer administered questionnaire. Categorical data were analyzed using Chi-square test and continuous variables were analyzed using analysis of variance (ANOVA) to determine association. Results: Prevalence of PTS was 45.5% (36/80) according to Villalta scale. Recurrent DVT (P = 0.0002), high BMI (P = 0.073), and previous venous in competence (P = 0.032), showed significant association with PTS. Proximal DVT demonstrated a strong association with PTS (P = 0.002). Residual thrombosis at 3 months was strongly associated with PTS (P &lt; 0.001), however, with a bias of very low sample with repeat duplex at 3 months post event. Awareness of PTS was extremely low (n = 0, 0%). Practice of elastic compression stockings (ECSs) use as a preventative measure of PTS failed to show any significant association (P = 0.61). Conclusions: This study showed a significant prevalence of PTS among patients with previous DVT. Development of PTS is probably multi factorial. A validated risk assessment tool should be used to identify at-risk patients as prevention is the best approach to this irreversible morbidity. J Curr Surg. 2022;12(2):38-44 doi: https://doi.org/10.14740/jcs459

Meta-analyses of sulodexide and other drugs in prevention and treatment of post-thrombotic syndrome.

Post-thrombotic syndrome (PTS) is a common chronic complication of deep vein thrombosis. Elastic compression (ECS) is the common pillar for PTS prevention and treatment, while the pharmacological approach for PTS includes direct oral anticoagulants (DOACs) and venoactive drugs (VADs) for prevention and treatment, respectively. Sulodexide can be used both in long-term prevention and in the treatment of PTS. To better understand the efficacy of the main drugs used in the prevention (sulodexide or DOACs) and treatment of PTS (sulodexide or VADs), pairwise meta-analyses of observational studies and RCTs were conducted. A literature search in MEDLINE, Embase, and Cochrane Library for observational studies and RCTs was performed. Incidence of PTS, reduction in PTS signs or symptoms and proportion of patients with complete venous ulcers healing were the primary outcomes for prevention and treatment of PTS, respectively. Fixed and Random effect model meta-analyses were performed. Heterogeneity and publication bias were assessed. R® software was used for the analysis. 893 articles were identified during the search. 8 observational studies (6 for DOACs and 2 for sulodexide) and 2 RCTs for sulodexide, out of the 11 studies included in the qualitative synthesis, were included for the prevention and treatment of PTS, respectively. Meta-analyses of observational studies showed an overall incidence of PTS of 15% (95% CI, 11-19) for sulodexide, and a 50% reduction of PTS signs and/or symptoms for rivaroxaban compared to warfarin (OR, 0.50; 95% CI, 0.38-0.65). The overall estimate of the two sulodexide RCTs showed a significant improvement in complete ulcer healing, with an OR of 2.32 (95% CI, 1.49-3.63). In prevention of PTS, sulodexide and rivaroxaban showed a low incidence and reduced risk of PTS respectively, while in PTS treatment, sulodexide was significantly effective in the complete ulcers healing. These results confirm the need to move from the traditional single-pillar approach with elastic compression stockings to a more effective multi-pillar approach, tailoring the treatment to each individual patient.

25 mm Hg versus 35 mm Hg elastic compression stockings to prevent post-thrombotic syndrome after deep vein thrombosis (CELEST): a randomised, double-blind, non-inferiority trial

The optimal strength of compression needed to prevent post-thrombotic syndrome (PTS) after a proximal deep vein thrombosis (DVT) is debated. We aimed to assess whether 25 mm Hg elastic compression stockings (ECS) are non-inferior to 35 mm Hg ECS in preventing PTS after a DVT. In this multicentre, double-blind, non-inferiority, randomised controlled trial, we enrolled adults (≥18 years) with a first ipsilateral proximal DVT attending 46 French vascular medicine hospital departments or private practices. Participants were randomly allocated (1:1, stratified by centre, age, and sex; with varying block sizes of two and four) to wear 25 mm Hg or 35 mm Hg ECS for 2 years. The primary outcome was the cumulative rate of PTS 2 years after inclusion, defined by a Villalta scale (≥5). Efficacy was assessed by intention-to-treat and in eligible participants who had complete primary outcome data. A per-protocol analysis was also conducted among compliant patients as a secondary outcome measure. Safety was assessed in all participants who used ECS at least once, and for which we have at least some tolerance information during follow-up. The margin for non-inferiority was 12·5%. This study is registered with ClinicalTrials.gov, NCT01578122, and has been completed. Between June 28, 2012, and July 21, 2017, we enrolled 341 eligible participants who consented to randomisation. 233 (68%) were men and median age was 59 years (IQR 45-70). Collection of ethnicity and race as a routine research variable is not authorised in France. Median follow-up was 735 days (IQR 721-760). 249 (73%) had complete data at 2 years. For the primary analysis, 40 (31%) of 129 participants with complete data in the 25 mm Hg ECS group and 40 (33%) of 120 in the 35 mm Hg group had PTS (absolute difference -2·3% [90% CI -12·1 to 7·4], pnon-inferiority=0·0062; relative risk 0·93, 95% CI 0·65 to 1·33). Results remained similar after imputation of missing data in patients we were authorised to do so: the cumulative proportion of PTS was 45 (29%) of 154 in the 25 mm Hg ECS group versus 52 (35%) of 148 in the 35 mm Hg ECS group (relative risk 0·83, 95% CI 0·60 to 1·16). Absolute difference was -5·9%, (90% CI -14·7 to 2·9), p=0·0003 for non-inferiority. Adherence was optimal (>80% and modified GIRERD score of 0-2) for 75 (51%) of 146 patients assigned to 25 mm Hg ECS and for 56 (42%) of 134 patients assigned to 35 mm Hg ECS (p=0·11). Regarding major adverse events related to ECS, there were no between-group differences in rates of deep vein thrombosis (0 vs 1 [0·6%]), ipsilateral leg ulcer (0 vs 1 [0·6%]), infection (0 vs 0), or death (0 vs 0) between the 169 patients evaluated in the 25 mm Hg ECS group and the 159 patients in the 35 mm Hg ECS group. Two (1%) of 328 patients who ever wore ESC developed ECS-related serious adverse events, one distal DVT and one leg ulcer (both in the 35 mm Hg ECS group). In the 25 mm Hg group, 6 patients died, 14 had a venous thromboembolic recurrence (proximal DVT or pulmonary embolism), and 7 had a major bleed. In the 35 mm Hg group, 5 patients died, 10 had a venous thromboembolic recurrence (proximal DVT or pulmonary embolism), and 6 had a major bleed. Although we did not reach the prespecified sample size, our results suggest that 25 mm Hg ECS are non-inferior to 35 mm Hg ECS in preventing PTS. Larger more powerful studies are needed. Laboratoires Innothera, France.

Lower strength stockings: is less better?

Post-thrombotic syndrome is a common complication of deep vein thrombosis characterised by chronic tiredness of the leg, cramps and leg pain in combination with oedema and irreversible skin changes, and ultimately venous ulceration of the leg.1 Treatment options are scarce and consist of immediate anticoagulation therapy to prevent thrombus propagation, and elastic compression stockings with the potential to enhance recanalization, and reduce the onset of post-thrombotic changes.2,3 More invasive strategies such as catheter directed thrombolysis have been studied, but combined results of the three most recent trials were disappointing.

Protein S Deficiency with Recurrent Deep Vein Thrombosis and Post Thrombotic Syndrome: A Case Report

deep vein thrombosis; protein S deficiency; rivaroxaban.

Treatment of Bilateral Venous Thrombosis in a Patient with Aplasia of the Inferior Vena Cava

The aim. In the treatment of venous thromboembolism, a special place is occupied by patients with congenital anomalies of the development of the inferior vena cava (IVC). To date, only single cases of treatment of this pathology have been described in the literature. Studying the experience of treating patients with congenital anomalies of the IVC will allow to improve the results of treatment of this category of patients.&#x0D; Materials and methods. Patient B., a 36-year-old man, applied to the vascular surgery clinic of the Vinnytsia Regional Pyrohov Clinical Hospital in July 2010 with complaints of pain, swelling, cyanosis of both lower extremities, which bothered the patient for about 10 days. The patient had no history of venous insufficiency of both lower extremities.&#x0D; An objective examination revealed cyanosis and swelling of both lower extremities.&#x0D; A duplex scan of both lower extremities revealed hyperechoic iliofemoral thrombosis of both lower extremities. Aplasia of the IVC was diagnosed. The common iliac veins on both sides formed a collateral that flowed into the left renal vein. The infrarenal segment of the inferior vena cava was absent. Thrombosis spread from tibial to popliteal, femoral, iliac veins with venous collateral thrombosis up to the level of the left renal vein.&#x0D; The patient received enoxaparin at a dose of 1 mg per kg of body weight twice a day for 7 days with subsequent transition to warfarin under the control of international normalized ratio. Warfarin was prescribed from a starting dose of 5 mg with subsequent control of international normalized ratio in the range of 2.0-3.0. Venotonic and anti-inflammatory drugs were also prescribed. In combination with drug therapy, class 2 elastic compression stockings were recommended.&#x0D; After the treatment, the patient’s condition improved, swelling and cyanosis of both lower extremities regressed. Repeated duplex scanning at the discharge of the patient from the hospital after 7 days showed signs of initial recanalization of the affected venous segments and no progression of thrombosis.&#x0D; Conclusions. Thus, this clinical case showed that the use of anticoagulant therapy allows to obtain satisfactory results in the treatment of patients with congenital anomalies of the development of IVC, to avoid the development of pulmonary embolism and other life-threatening conditions. At the same time, such patients need regular follow-up examinations in order to adjust the treatment and prevent the development of IVC syndrome.

Measurement of Skin Thickness Using Ultrasonography to Test the Usefulness of Elastic Compression Stockings for Leg Edema in Pregnant Women.

Background: One of the most common treatments for leg edema during pregnancy is the use of compression stockings. The purpose of this study was to evaluate the objective effectiveness in pregnant women, by measuring the changes of skin thickness using ultrasonography. Methods: Pregnant women were diagnosed with leg edema using the pitting edema method at 36 weeks of gestation. Twenty-four pregnant women (48 legs) with leg edema spent time without wearing elastic stockings at 36–37 weeks of gestation. Then, they wore elastic stockings for one week at 37–38 weeks of gestation. We measured the grade of edema (from 0 to 3) and the skin thickness of the lower leg by portable ultrasonography at 36, 37, and 38 weeks of gestation (a before-and-after study). Results: In 24 pregnant women, thigh edema was not detected in any of the 48 legs before or after the use of elastic stockings. All 48 legs in 24 pregnant women had physiological lower leg edema, but not thigh edema. The average grade of pitting edema in each lower leg significantly decreased after using the stockings (36 weeks, 1.77 ± 0.85; 37 weeks, 1.79 ± 0.77; 38 weeks, 1.04 ± 0.74, p < 0.0001). In addition, the skin thickness of the lower legs was significantly decreased after the use of elastic stockings (36 weeks, 7.47 ± 2.45 mm; 37 weeks, 7.93 ± 2.83 mm; 38 weeks, 7.15 ± 2.35 mm, p < 0.0001). Conclusions: The wearing of elastic compression stockings on the lower legs is objectively effective for improving leg edema in pregnant women.

214 Laparoscopic Cholecystectomy: Most Primeval and Pervasive Yet Least Congruent

Abstract Aim Laparoscopic Cholecystectomy is one of the commonest surgical procedures performed worldwide. However, there is considerable variation in laparoscopic cholecystectomy practice, and a lack of robust data on variations in practices. Method A 45-item electronic survey was designed to capture global variations in practice of laparoscopic cholecystectomy. The survey was disseminated to the global community of surgeons performing laparoscopic cholecystectomy through professional surgical and training organizations and social media. Results 638 surgeons from 70 countries completed the survey. Pre-operatively 5.6% routinely performed an endoscopy to rule out peptic ulcer disease. Cholecystectomy theatre lists were provided acutely by 58.6%, with 61.2% (n=389) performing index admission cholecystectomy for gallstone pancreatitis. Peri-operative practice included the use of prophylactic antibiotics (n=362) and elastic compression stocking routinely by over half of the respondents. However, 69.7% do not use pharmacological DVT prophylaxis preoperatively. Open juxta umbilical is the preferred method of pneumoperitoneum (n=410, 64.6%). The most common approach to difficult Calot's triangle is retrograde dissection from fundus (49.2%, n= 312). Transection of the gallbladder in the middle and retrograde dissection is practiced by about 18% of surgeons (n=114). Local anesthetic is instilled into the gallbladder bed by 14.2% of surgeons. Half of the surgeons discharge their patients on the following day, while around 44% would discharge them on the same day. Conclusions This study highlights significant variations in practices concerning various aspects of laparoscopic cholecystectomy and stressed on the need for developing consensus guidelines.