Elastic Compression Stockings Research Articles

Superficial venous thrombosis in Behçet’s disease: a case report and a review of the literature

Superficial venous thrombosis in Behcet’s disease: a case report and a review of the literature Mohammed El Amine Ghembaza,1,2 Ali Lounici1,2 1Department of Internal Medicine, Hospital University Tidjani Damerdji, Tlemcen, Algeria; 2Faculty of Medical Sciences, University of Abou Bekr Belkaid, Tlemcen, Algeria Abstract: Behçet’s disease is a relapsing–remitting vasculitis that affects both arterial and venous vessels of various sizes. A 48-year-old man with Behçet’s disease was seen at the outpatient clinic of our hospital for painful lesions on his left leg. Physical examination showed two tender erythematous linear indurations on the medial side of the left thigh and calf, of about 3 cm and 10 cm in length, respectively. Duplex ultrasonography revealed echogenic material in the lumen of collateral superficial veins, with no extension to the deep venous system. The patient was started on once-daily subcutaneous low-molecular-weight heparin in combination with elastic compression stockings, with spectacular improvement. Superficial venous thrombosis is a common manifestation of Behçet’s disease, and the diagnosis is based on clinical features. Superficial venous thrombosis has a dual prognostic value: on one hand, it should raise the suspicion of concomitant deep venous and/or arterial involvement, and on the other hand, it may predict the development of future severe visceral manifestations. Keywords: Behçet’s disease, vasculitis, vascular involvement, venous thrombosis, superficial vein thrombosis

Comparison of 15-20 mmHg versus 20-30 mmHg Compression Stockings in Reducing Occupational Oedema in Standing and Seated Healthy Individuals.

Background Elastic compression stockings (ECS) are effective in preventing and reducing occupational edema (OE), but the optimal pressure according to the prevalent working position during the day is still controversial. Objective To compare the effectiveness of ECS with different pressures (15–20 mmHg or 20–30 mmHg) for reducing OE in individuals working in different prolonged postures. Methods This cross-sectional study comprised 116 lower limbs of 58 individuals divided into three groups according to their prevalent postures over the day (sitting, standing, or combination). Volumetric measurements were taken at the beginning and at the end of three consecutive days. On the first day, individuals did not use compression stockings; on the second and third days, they used, respectively, 15–20 mmHg and 20–30 mmHg knee-length stockings. Differences between morning and evening volumes (measured edema) were calculated, compared, and correlated. Results Volumetric variations were significantly lower on the second compared to the first day when individuals in all three groups used 15–20 mmHg compression stockings (p-value < 0.001). Measurements were even lower when they used 20–30 mmHg stockings: this decrease was more significant for the sitting (p-value < 0.001) than the standing (p-value < 0.05) and combined groups (p-value < 0.05). Reduction of measured edema was more significant in individuals working in a prolonged seated position. No significant difference was found only on comparing sitting and standing groups after the use of the 15–20 mmHg compression stockings. Conclusions The use of ECS over a working day reduces OE in prolonged sitting, standing, and combined positions, with the reductions being greater with the higher pressure.

Profilaxia do tromboembolismo venoso em viagens de longa duração

Objective: Venous thromboembolism (VTE) can result in significant morbidity and mortality. Air travel can triple the risk of VTE. Family doctors can play a role in the prevention of this problem. The aim of this study was to review the evidence for prevention of thromboembolism on long-haul flights. Data sources: MEDLINE, National Guideline Clearinghouse, Guidelines Finder, Canadian Medical Association Practice Guidelines Infobase, Scottish Intercollegiate Guidelines, The Cochrane Library, Clinical Evidence, DARE, Bandolier, Direção-Geral da Saúde and Sociedade Portuguesa de Medicina Interna. Revision methods: Guidelines, systematic reviews (SR), meta-analyses and original studies published between 2004 and 2014 were surveyed, using the keywords ‘venous thrombosis’, ‘prevention and control’ and ‘air travel’. To evaluate the levels of evidence and strength of recommendations, the Strength of Recommendation Taxonomy (SORT) scale of American Academy of Family Physicians was used. Results: Among the 121 articles found, 12 were selected including seven guidelines and five systematic reviews. Most articles stress the importance of individualized assessment of the risk of VTE before air travel. General measures are recommended for most of the population (SORT C). Elastic compression stockings should be used in people with risk factors and previous VTE (SORT B). Pharmacological prophylaxis can be reserved for high risk patients using low molecular weight heparin (SORT C). The use of aspirin is not recommended (SORT B). Conclusions: The findings are limited by the methodology of the studies, as well as by the population to which the results are applied. Until methodologically adequate studies are available, the decision regarding prophylaxis of VTE on long trips must be considered on an individual basis.

Beneficial Effect of Endovascular Treatment on Villalta Score in Japanese Patients With Chronic Iliofemoral Venous Thrombosis and Post-Thrombotic Syndrome.

Post-thrombotic syndrome (PTS), the most common complication of deep venous thrombosis (DVT), develops in ≥50% of patients with iliofemoral DVT. However, the benefit of endovascular treatment in Japanese patients with chronic DVT and PTS remains unclear. Methods and Results: Between June 2014 and May 2016, endovascular treatment was performed in 11 consecutive Japanese patients with chronic iliofemoral DVT and PTS refractory to anticoagulant therapy and elastic compression stockings. We evaluated the technical success rate, complications, patency, Villalta score, calf circumference, and popliteal vein reflux in both the acute stage (the day following endovascular treatment) and chronic stage (after 6 months). Imaging follow-up included venous duplex scanning and/or magnetic resonance venography. The technical success rate was 81.8%, without complications. In patients with successful intervention, the Villalta score improved significantly, from 9.0±3.7 preoperatively to 3.6±2.5 in the acute phase (P<0.01) and 2.9±2.1 in the chronic phase (P<0.001). The bilateral difference in lower thigh circumference also improved significantly, from 2.6±1.0 cm preoperatively to 1.4±1.0 cm in the chronic phase (P<0.001). However, popliteal vein reflux did not improve. In patients with successful intervention, venous patency rate was 100% at 6 months post-intervention. Endovascular treatment is safe and effective in Japanese patients with chronic iliofemoral DVT and PTS.

Activities and effects of a qualification system for elastic compression stocking appliers of the Japanese Society of Phlebology

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Predicting Post-Thrombotic Syndrome with Ultrasonographic Follow-Up after Deep Vein Thrombosis: A Systematic Review and Meta-Analysis.

Post-thrombotic syndrome (PTS) is a common and potential severe complication of deep venous thrombosis (DVT). Elastic compression stocking therapy may prevent PTS if worn on a daily basis, but stockings are cumbersome to apply and uncomfortable to wear. Hence, identification of predictors of PTS may help physicians to select patients at high risk of PTS. This article identifies ultrasonography (US) parameters assessed during or after treatment of DVT of the leg, that predict PTS. This is a systematic review and meta-analysis study. Databases were searched for prospective studies including consecutive patients with DVT who received standardized treatment, had an US during follow-up assessing findings consistent with vascular damage after DVT and had a follow-up period of at least 6 months for the occurrence of PTS assessed by a standardized protocol. The literature search revealed 1,156 studies of which 1,068 were irrelevant after title and abstract screening by three independent reviewers. After full-text screening, 12 relevant studies were included, with a total of 2,684 analysed patients. Two US parameters proved to be predictive of PTS: residual vein thrombosis, for a pooled odds ratio (OR) of 2.17 (95% confidence interval [CI], 1.79-2.63) and venous reflux at the popliteal level, for a pooled OR of 1.34 (95% CI, 1.03-1.75). The US features reflux and residual thrombosis measured at least 6 weeks after DVT predict PTS. Whether these features may be used to identify patients who may benefit from compression therapy remains to be assessed in further studies.

The presence of elastic compression stockings reduces the fluid responsiveness of patients in the operating room.

The aim of this study was to investigate whether elastic compression stockings (ECS) can affect fluid responsiveness parameters before and during passive leg raising (PLR) maneuvers. In the operating room (OR), we performed a prospective study including patients referred for cardiac surgery. Blood pressure (BP), ΔPP, heart rate (HR), central venous pressure (CVP), stroke volume (SV) and aortic blood flow (ABF) (by esophageal doppler) were measured according to four conditions: supine position without ECS (baseline 1), lower limbs raised to an angle of 45° (PLR 1), returned to the supine position with ECS (baseline 2), then a second PLR maneuver with ECS was performed (PLR 2). Twenty patients were included. BP, SV, ABF and CVP increased significantly. ΔPP and HR decreased during PLR 1. At baseline 2, HR and ΔPP decreased significantly compared to baseline 1. During PLR 2, increase of SV (4% [9]) and ABF (4% [9]), and the decrease of ΔPP (-19% [104]) were significantly lower than those observed at PLR 1 (7% [21] P=0.05; 9% [8] P=0.02 and -66% [40] P=0.02, respectively). Eleven patients presented a ΔPP≥13% at baseline 1. Only 1 patient still presented a ΔPP≥13% with ECS at baseline 2. Only 3/9 patients with an increase of ABF ≥10% and 2/11 patients with an increase of PP ≥12% during the PLR 1 presented similar results during PLR 2. In the OR, ECS provoke a self-fluid loading increasing ABF, decreasing ΔPP and PLR response. The presence of ECS should be considered when managing hemodynamic parameters of patients.

Development of a clinical prediction model for the postthrombotic syndrome in a prospective cohort of patients with proximal deep vein thrombosis

Background Postthrombotic syndrome (PTS) is a chronic complication that develops in 20-50% of patients after deep vein thrombosis (DVT). Although individual risk factors for PTS have been characterized, the ability to predict which DVT patients are likely to develop PTS remains limited. Objective To develop a clinical prediction score for PTS in patients with DVT. Methods The derivation cohort consisted of participants in the SOX Trial, a randomized double-blind placebo-controlled trial of elastic compression stockings versus placebo stockings worn for 2years after DVT to prevent PTS in patients with a first proximal DVT, enrolled in 24 community and tertiary-care hospitals from 2004 to 2010. Multivariable logistic regression analysis of baseline characteristics was performed. The outcome was the occurrence of PTS, diagnosed starting from 6months or later according to Ginsberg's criteria. Results Seven hundred and sixty-two patients were included in the analysis. The median follow-up was 728days. The model includes three independent predictors, and has a range of possible scores from 0 to 5. High-risk predictors were: index DVT in the iliac vein; body mass index of ≥35kgm-2 ; and moderate-severe Villalta severity category at DVT diagnosis. As compared with patients with a score of 0, those with a score of ≥4 had an odds ratio of 5.9 (95% confidence interval 2.1-16.6) for developing PTS. Conclusions To our knowledge, this is the first clinical prediction score for PTS. We identified three independent predictors that, when combined, predicted PTS risk after a first proximal DVT. The SOX-PTS score requires external validation before it can be considered for clinical use.

Acute Effects of Graduated Elastic Compression Stockings in Patients with Symptomatic Varicose Veins: A Randomised Double Blind Placebo Controlled Trial

To investigate the effectiveness of graduated elastic compression stockings (GECS) below the knee in improving symptoms in patients with varicose veins in the absence of high quality evidence. This was a randomised double blind placebo controlled trial. Thirty patients with no experience of elastic stockings, presenting with primary varicose veins causing calf pain or aching were randomised to a GECS (18-21 mmHg at the ankle level, n=15) or a placebo stocking (0 mmHg, n=15). Pain or aching of the index leg after 1 week was the primary outcome measure. In patients with bilateral varicose veins the leg with the most severe pain/aching was considered. Other defined symptoms were secondary outcome measures. All symptoms were scored on a visual analogue scale (VAS). The two study groups were well balanced at baseline. At the completion of the study after 1 week, GECS were more effective than placebo stockings in reducing pain or aching (VAS score 1.7±3.0 vs. 4.5±2.8 for placebo, p=.02), while non-significant trends were observed for some of the remaining symptoms of the index leg, including feeling of swelling (VAS score 0.9±1.9 vs. 3.3±3.5 for placebo), paraesthesiae (VAS score 0.2±0.6 vs. 2.1±3.1 for placebo), and the number of symptoms other than pain or aching (1.3±1.1 vs. 2.8±1.7 for placebo). Number needed to treat (95% CI) for a 50% or complete improvement of pain or aching in the index leg was 2 (95% CI 1.2–5.5) and 2 (95% CI 1.2–5.3), respectively. Mean daily use of the placebo stockings and GECS was 8.0 hours and 10.2 hours, respectively (p=.13). Among patients with varicose veins, GECS seem effective in ameliorating symptoms, particularly pain or aching, compared with placebo stockings after 1 week of use. Long-term studies are justified.

Effects of the use of elastic compression stockings among dental hygienists

Effects of the use of elastic compression stockings among dental hygienists

Individualised versus standard duration of elastic compression therapy for prevention of post-thrombotic syndrome (IDEAL DVT): a multicentre, randomised, single-blind, allocation-concealed, non-inferiority trial

Therapy with elastic compression stockings has been the cornerstone for prevention of post-thrombotic syndrome for decades in patients after acute deep venous thrombosis. It is uncertain who benefits most from therapy, and what the optimum duration of therapy should be. We therefore aimed to assess the safety and efficacy of individualised duration of compression therapy versus the standard duration of 24 months following an initial treatment period of 6 months. We did a multicentre, randomised, single-blind, allocation-concealed, non-inferiority trial at 12 hospitals in the Netherlands and two in Italy. We randomly assigned patients (1:1) with acute proximal deep vein thrombosis of the leg and without pre-existent venous insufficiency (Clinical Etiological Anatomical and Pathophysiological score <C3) to receive either individualised duration of elastic compression therapy or standard duration of therapy for 24 months following an initial treatment period of 6 months. Randomisation was done with a web-based automatic randomisation programme (TENALEA) and a random block size (2-12), and was stratified by centre, age, and body-mass index. In the initial phase, compression was applied within 24 h of diagnosis according to three prespecified protocols. All patients received elastic compression stockings (30-40 mm Hg) for 6 months, and were instructed to wear them every day during ambulant hours. Thereafter treatment was tailored on the basis of clinical signs and symptoms scored according to the Villalta post-thrombotic syndrome scale; patients assigned to individualised therapy with two consecutive Villalta scores of 4 or less were instructed to stop using the stockings. Patients were followed up for 2 years and assessed at five clinic visits at study inclusion, and 3, 6, 12, and 24 months after diagnosis (stocking allocation was not revealed to the assessors). The primary outcome was the proportion of patients with post-thrombotic syndrome at 24 months diagnosed according to original Villalta criteria (a score of ≥5 on two consecutive occasions at least 3 months apart) assessed by intention to treat. The predefined non-inferiority margin for the difference in success rates was set at 7·5%. This study has been completed and is registered with ClinicalTrials.gov, number NCT01429714. Between March 22, 2011, and July 1, 2015, we enrolled 865 patients and randomly assigned 437 to individualised duration compression stockings and 428 to standard duration. 283 (66%) of 432 patients in the intervention group were advised before 24 months to stop wearing elastic compression stockings (236 [55%] of 432 patients after 6 months, and 47 [11%] of 432 at 12 months). Post-thrombotic syndrome occurred in 125 (29%) of 432 patients receiving individualised duration of therapy and in 118 (28%) of 424 receiving standard duration of therapy (odds ratio for difference 1·06, 95% CI 0·78 to 1·44). The absolute difference was 1·1% (95% CI -5·2 to 7·3), thus meeting the non-inferiority margin. 24 patients died, 17 (4%) in the individualised treatment group and seven (2%) in the standard duration group, but no deaths were related to treatment. No serious adverse events related to the intervention occurred. Individualised therapy with elastic compression stockings for the prevention of post-thrombotic syndrome was non-inferior to standard duration of therapy of 24 months. Individualising the duration is effective and could shorten the length of therapy needed, potentially enhancing patients' wellbeing. ZonMw (Netherlands).

Acute Effects of Graduated Elastic Compression Stockings in Patients with Symptomatic Varicose Veins: A Randomised Double Blind Placebo Controlled Trial

To investigate the effectiveness of graduated elastic compression stockings (GECS) below the knee in improving symptoms in patients with varicose veins in the absence of high quality evidence. This was a randomised double blind placebo controlled trial. Thirty patients with no experience of elastic stockings, presenting with primary varicose veins causing calf pain or aching were randomised to a GECS (18-21mmHg at the ankle level, n=15) or a placebo stocking (0mmHg, n=15). Pain or aching of the index leg after 1 week was the primary outcome measure. In patients with bilateral varicose veins the leg with the most severe pain/aching was considered. Other defined symptoms were secondary outcome measures. All symptoms were scored on a visual analogue scale (VAS). The two study groups were well balanced at baseline. At the completion of the study after 1 week, GECS were more effective than placebo stockings in reducing pain or aching (VAS score 1.7±3.0 vs. 4.5±2.8 for placebo, p=.02), while non-significant trends were observed for some of the remaining symptoms of the index leg, including feeling of swelling (VAS score 0.9±1.9 vs. 3.3±3.5 for placebo), paraesthesiae (VAS score 0.2±0.6 vs. 2.1±3.1 for placebo), and the number of symptoms other than pain or aching (1.3±1.1 vs. 2.8±1.7 for placebo). Number needed to treat (95% CI) for a 50% or complete improvement of pain or aching in the index leg was 2 (95% CI 1.2-5.5) and 2 (95% CI 1.2-5.3), respectively. Mean daily use of the placebo stockings and GECS was 8.0hours and 10.2hours, respectively (p=.13). Among patients with varicose veins, GECS seem effective in ameliorating symptoms, particularly pain or aching, compared with placebo stockings after 1 week of use. Long-term studies are justified.

Beneficial effect of MPFF administration on the healing process of venous ulcer

Venous hypertension underlies all clinical manifestations of chronic venous insufficiency (CVI). It is transmitted to the microcirculation and results in capillary changes which lead to edema, skin damage and eventually venous ulceration. The venoactive drugs are believed to have a therapeutic effect in venous disorders. This study evaluated the effect on the healing process of venous leg ulcers of systemic treatment with a semi-synthetic micronized purified flaνοnoid fraction (MPFF). The study population comprised 60 patients with CVI and venous ulcer of the lower extremities, who were randomised into three groups, each of 20 patients. The patients in group Α, considered as the control group, used only elastic compression stockings. Group Β patients used elastic compression stockings and took MPFF 500mg orally, twice daily, until the complete healing of the ulcer. Group C used elastic compression stockings, and took MPFF 500mg twice daily until the complete healing of the ulcer, plus antibiotics. The ulcer healing rate was measured based on the healing index Η = (D0-Dx/D0) × 100, where D is the day from starting treatment. Venous blood samples were collected from each patient, before, and 20 and 40 days after the beginning of treatment, from the ulceration site and from an upper extremity vein (systemic circulation), for measurement of the white blood cells (WBCs). Healing time was statistically significantly shorter in groups Β and C than in the control group Α (p = 0.01 and p = 0.001, respectively). The difference between groups Β and C was not significant. Comparison between the initial blood sample and that after 20 days of treatment showed that the WBC trapping rate in the capillaries around the ulcer was reduced by half with the administration of MPFF. Administration of MPFF has a beneficial effect on capillary permeability and improves the microcirculation, with particular effect on the WBCs trapped in the capillaries around the venous leg ulcer. As a consequence MPFF administration improves the healing rate of the venous ulcers.

Compression therapy for prevention of post-thrombotic syndrome.

Post-thrombotic syndrome (PTS) is a long-term complication of deep vein thrombosis (DVT) that is characterised by chronic pain, swelling, and skin changes in the affected limb. One of every three people with DVT will develop post-thrombotic complications within five years. Several non-pharmaceutical measures are used for prevention of post-thrombotic syndrome during the acute phase of DVT. These include elevation of the legs and compression therapy. Clinicians and guidelines differ in their assessment of the utility of compression therapy for treatment of DVT. This is an update of a review first published in 2003. To determine relative effectiveness and rate of complications when compression therapy is used in people with deep vein thrombosis (DVT) for prevention of post-thrombotic syndrome (PTS). For this update, the Cochrane Vascular Information Specialist (CIS) searched the Cochrane Vascular Specialised Register (20 March 2017) and CENTRAL (2017, Issue 2). The CIS also searched trial registries for details of ongoing or unpublished studies. We included randomised controlled trials (RCTs) and controlled clinical trials (CCTs) of compression therapy, such as bandaging and elastic stockings, in people with clinically confirmed DVT. The primary outcome was the occurrence of PTS. Two review authors (DK and EvL) identified and assessed titles and abstracts for relevance, and a third review author (DA) verified this assessment independently. Review authors imposed no restrictions on date or language of publications. Three review authors (DA, DK, EvL) used data extraction sheets to independently extract study data. We resolved disagreements by discussion. We identified 10 RCTs with a total of 2361 participants that evaluated compression therapy. The overall methodological quality of these trials was low. We used only five studies in meta-analysis owing to differences in intervention types and lack of data. Three studies compared elastic compression stockings (pressure of 30 to 40 mmHg at the ankle) versus no intervention. Two studies compared elastic compression stockings (pressure 20 to 40 mmHg) versus placebo stockings. Overall, use of elastic compression stockings led to a clinically significant reduction in the incidence of PTS (risk ratio (RR) 0.62, 95% confidence interval (CI) 0.38 to 1.01; P = 0.05; 1393 participants; 5 studies; low-quality evidence); no reduction in the incidence of severe PTS (RR 0.78, 95% CI 0.53 to 1.15; P = 0.21; 1224 participants; 4 studies; low-quality evidence); and no clear difference in DVT recurrence (RR 0.94, 95% CI 0.69 to 1.28; 1212 participants; 4 studies; P = 0.69; low-quality evidence). We did not pool data on the incidence of pulmonary embolism because this information was poorly reported, but we observed no differences between groups included in individual studies (low-quality evidence).Two studies evaluated effects of compression in the acute phase versus no compression treatment and found no differences in the incidence of PTS (RR 0.76, 95% CI 0.49 to 1.16; P = 0.2; 101 participants). One study reported that thigh-length stockings did not provide better protection against development of PTS than knee-length stockings (RR 0.92, 95% CI 0.66 to 1.28; P = 0.6; 267 participants). Another trial reported that wearing compression stockings for two years seemed to be superior to wearing them for one year in terms of PTS incidence.Two of the 10 included studies described patient satisfaction and quality of life (moderate-quality evidence), using different measurement systems. The first study showed significant improvement in well-being and DVT-related quality of life with compression treatment (P < 0.05) compared with bed rest, and the second study showed no differences in quality of life scores between compression and placebo groups. Four studies poorly reported side effects (low-quality evidence) that included itching, erythema, and other forms of allergic reaction and described no serious adverse events. Compliance with wearing of compression stockings was generally high but varied across studies. Low-quality evidence suggests that elastic compression stockings may reduce the occurrence of PTS after DVT. We downgraded the quality of evidence owing to considerable heterogeneity between studies and lack of or unclear risk of blinding due to clinical assessment scores. No serious adverse effects occurred in these studies. Large randomised controlled trials are needed to confirm these findings because of current lack of high-quality evidence and considerable heterogeneity.

Factors of compliance with the wearing of elastic compression stockings in a Sub-Saharan population

Elastic venous compression is the basic treatment of chronic venous insufficiency (CVI) and deep vein thrombosis (DVT). Very little data exist in sub-Saharan Africa concerning the wearing of compression stockings. To determine the factors of compliance with wearing elastic compression stockings. This retrospective cross-sectional descriptive and analytical study involved 200 consecutive patients (93 cases of DVT, 94 cases of CVI, 13 cases of DVT and CVI). Data on compliance with wearing compression stockings and the factors influencing this compliance were collected. The average age was 51±15 years old (range 17 and 91 years old). The sex ratio was 1. The majority of patients (78.5%) performed their occupation in a standing position, for more than 8hours per day for 80.5%. DVT were preferentially on the left side (52.9%) and proximal (44.4%). Concerning the CVI, the predominant symptoms were class C3 (52.3%), C4 and C5 (43.9%) of the CEAP classification. Bilateral involvement was dominant (53.3%) and the large saphenous vein was the most affected (66.9%) compared with 33.1% for the small saphenous vein exclusively. The most common type of stockings prescribed was the lower mid-thighs (57%), followed by the pantyhose (30%), in classes 3 (63%) and 2 (36.5%). The majority of patients (75%) agreed to wear their stockings after prescription with a good compliance rate of 58.5% at the beginning of the prescription. At the time of the study, this rate was 11%. The optimal duration of compliance with wearing compression stockings was 6 months (64%). Over 12 months this rate fell to 7.5%. The main causes were stocking-related compression discomfort (36.7%), patient neglect (21.5%), threading difficulties (16.9%), and an unfavorable working environment (8.7%). The determining factors of compliance with wearing of stockings were living in a couple (68.4% vs 54.2, P=0.04), CVI (53% vs 38.2%, P=0.04) and C3 (39% vs 80%), C4 (37.5% vs 17%), C5 (18% vs 3%) CVI (P=0.0005). Compliance with wearing elastic compression stockings is mediocre. The main factors of non-compliance are discomfort, threading difficulties and patient neglect.

Economy class syndrome: what is it and who are the individuals at risk?

The term ‘economy class syndrome’ refers to the occurrence of thrombotic events during long-haul flights that mainly occur in passengers in the economy class of the aircraft. This syndrome results from several factors related to the aircraft cabin (immobilization, hypobaric hypoxia and low humidity) and the passenger (body mass index, thrombophilia, oral contraceptives or hormone replacement therapy, cancer), acting together to predispose to excessive blood coagulation, which can result in venous thromboembolism. Several risk factors, both genetic and acquired, are associated with venous thromboembolism. The most important genetic risk factors are natural anticoagulant deficiencies (antithrombin, protein C and protein S), factor V Leiden, prothrombin and fibrinogen gene mutations and non-O blood group individuals. Acquired risk factors include age, pregnancy, surgery, obesity, cancer, hormonal contraceptives and hormone replacement therapy, antiphospholipid syndrome, infections, immobilization and smoking. People who have these risk factors are predisposed to hypercoagulability and are more susceptible to suffer venous thromboembolism during air travel. For these individuals, a suitable outfit for the trip, frequent walks, calf muscle exercises, elastic compression stockings and hydration are important preventive measures. Hence, it is essential to inform about economic class syndrome in an attempt to encourage Brazilian health and transport authorities to adopt measures, in partnership with the pharmaceutical industry, to prevent venous thromboembolism.

Maintenance of the Results of Stage II Lower Limb Lymphedema Treatment after Normalization of Leg Size.

Objective The aim of this study was to identify strategies to transfer responsibility of the maintenance of the results of lymphedema treatment to the patient. Methods Maintenance of the reduction of edema was evaluated in a prospective clinical trial in patients with Stage II leg lymphedema. Twenty-one lymphedematous lower limbs were evaluated in Clínica Godoy in 2014 and 2016. The evaluation was done by volumetry at baseline and weekly thereafter for volume control. Patients wore Venosan® cotton 20/30 and 30/40 mmHg elastic compression stockings followed by a custom-made inelastic stocking made of grosgrain fabric. The Friedman test for multiple comparisons and Conover post hoc test were used for statistical analysis with an alpha error of 5%. Results On comparing leg volume changes using the different types of stockings, the 20/30 mmHg elastic compression stockings failed in the first week to maintain the volume reductions but the 30/40 mmHg compression stockings did not allow significant increases in volume (p value > 0.05). During one week, the grosgrain stocking reduced leg volumes to baseline values (p value = 0.24). Conclusion Higher compression of elastic stockings is better than lower compression but the inelastic grosgrain stocking is even better than both to maintain the results.

健常成人における弾性ストッキング装着前後の血圧脈波の変化と影響を及ぼす因子の検討

弾性ストッキング装着による血圧脈波の変化と，その変化に影響を及ぼす因子について検討した．足関節上腕血圧比（ABI）が1.0以上1.4以下の健常成人20名40肢を対象とした．ハイソックスタイプ15～20mmHg（つま先あき）の装着前と装着後に，各5分間以上安静臥床後，血圧脈波検査を実施した．下肢血圧指標の変化には体格に係わる因子が影響し，脈波の変化には年齢や性別などが影響因子となった．ハイソックス装着前後の補正群差を比較した結果，足関節収縮期血圧は平均8mmHg低下した（95％CI：6～10mmHg，p<0.001）．ABIは平均0.07低下した（95％CI：0.05～0.08，p<0.01）．Upstroke timeは平均16ms延長した（95％CI：14～19，p<0.001）．第１足趾血圧，足趾上腕血圧比，％Mean arterial pressure，上腕収縮期血圧は，有意な変化を認めなかった．弾性ストッキングの足首表示圧に比して足関節血圧への影響は小さかった．足関節血圧は，身体的特徴が小柄で痩身，足首周径が細いほど低下することが示唆された.

Patients' perceptions and experiences of the prevention of hospital-acquired thrombosis: a qualitative study

ObjectiveTo examine patients' understanding of hospital-associated thrombosis, and their experiences of thromboprophylaxis.DesignQualitative study using semi-structured interviews with 31 patients requiring venous thromboembolism (VTE) prophylaxis following a recent hospital admission. Interviews...

Incidence of deep vein thrombosis in patients undergoing breast reconstruction with autologous tissue transfer.

Background Breast reconstruction is associated with multiple risk factors for venous thromboembolism. However, the incidence of deep vein thrombosis in patients undergoing breast reconstruction is uncertain. Objective The aim of this study was to prospectively evaluate the incidence of deep vein thrombosis in patients undergoing breast reconstruction using autologous tissue transfer and to identify potential risk factors for deep vein thrombosis. Methods Thirty-five patients undergoing breast reconstruction were enrolled. We measured patients' preoperative characteristics including age, body mass index (kg/m2), and risk factors for deep vein thrombosis. The preoperative diameter of each venous segment in the deep veins was measured using duplex ultrasound. All patients received intermittent pneumatic pump and elastic compression stockings for postoperative thromboprophylaxis. Results Among the 35 patients evaluated, 11 (31.4%) were found to have deep vein thrombosis postoperatively, and one patient was found to have pulmonary embolism postoperatively. All instances of deep vein thrombosis developed in the calf and were asymptomatic. Ten of 11 patients underwent free flap transfer, and the remaining one patient received a latissimus dorsi pedicled flap. Deep vein thrombosis incidence did not significantly differ between patients with a free flap or pedicled flap (P = 0.13). Documented risk factors for deep vein thrombosis demonstrated no significant differences between patients with and without deep vein thrombosis. The diameter of the common femoral vein was significantly larger in patients who developed postoperative deep vein thrombosis than in those who did not ( P < 0.05). Conclusions The morbidity of deep vein thrombosis in patients who underwent breast reconstruction using autologous tissue transfer was relatively high. Since only the diameter of the common femoral vein was predictive of developing postoperative deep vein thrombosis, postoperative pharmacological thromboprophylaxis should be considered for all patients undergoing breast reconstruction regardless of operative procedure.