Use Of Compression Stockings Research Articles

A multicenter review of epidemiology and management of varicose veins for national guidance.

BackgroundVaricose vein is a common surgical problems in India. This study was done to assess the clinico-epidemiological profile, risk factors and management practices in varicose veins.Materials and methodsMedical records of 170 varicose vein cases admitted in tertiary care hospitals in Mangalore between May 2011 to April 2014 were reviewed retrospectively.ResultsMajority of cases 53(31.2%) were of the age group 41–50 years. Majority were males 127(74.7%) and majority were unskilled workers 101(59.4%). Superficial veins were involved in 123(72.4%) cases. Perforator followed by great saphenous vein were most frequently involved. Veins on the left side were more involved than on the right. Common symptoms at the time of presentation was ulceration 98(57.6%) followed by pain in the legs 96(56.5%). Ulceration was seen significantly more among females (p = 0.027) and among house wives (p = 0.004). Complications like eczema 46(27.1%), non-healing ulcers 21(12.3%) and deep vein thrombosis 10(5.9%) were reported among cases. Eczema was present significantly more among elderly patients aged above 60 years (p = 0.019). Risk factors like prolonged standing was observed in 86(50.6%) cases. This history was significantly seen among males (p = 0.001) and among those involved in unskilled occupations (p < 0.001). Recurrence of varicose vein was reported in 23(13.5%) cases. It was associated with patients of the age group 21–30 years (p = 0.021). Doppler ultrasound was the most common 120(70.6%) investigation done. Micronized purified flavonoid fraction was used in management in 15(8.8%) cases. Conservative management methods like limb elevation 50(29.4%) and compression stocking 36(21.2%) was advised to patients. Saphenous vein stripping was the most common surgical procedure 40(23.5%) performed.ConclusionThe high risk groups identified in this study need to be made aware of risk of developing varicose veins. Use of compression stocking at work place added with newer procedure in management could help in betterment in their quality of life.

Prophylactic use of anticoagulation and hemodilution for the prevention of venous thromboembolic events following meningioma surgery

ObjectivesBrain tumors may be associated with postoperative venous thromboembolic (VTE) events with possible devastating consequences. Meningioma has the highest incidence of postoperative VTE events among all brain tumors. Hemodilution and anticoagulation both proved efficacy in deep venous thrombosis (DVT) prophylaxis that is why we theorized that this regimen would be beneficial for VTE prophylaxis in operated intracranial meningioma patients without added risk to the patients. Patients and methodsA retrospective double-blinded study, where the records of consecutive intracranial meningioma patients were revised comparing the efficacy of two regimens of postoperative VTE prophylaxis. Patients were divided into 2 groups; group A was submitted to the use of compressive stockings, low-molecular weight heparin (LMWH) administration and hemodilution, while group B was submitted only to the use of compressive stockings. ResultsThe study included 194 patients. Mean age of patients was 55 years (range from 27 to 78 years). VTE events were diagnosed in 16 patients (8.2%) all of them belonged to group B. The median time for VTE events was 12 days. Older age (P=.0001), larger size tumor (p=0.0438), delayed ambulation postoperatively (p=0.0351) as well as skull base location of meningioma (p=0.0163) were associated with higher incidence of postoperative VTE. Overall, group A patients showed more favorable outcome as compared to group B. ConclusionIn addition to the use of elastic stockings, we recommend starting hemodilution at the outset of surgery, LMWH administration starting 12h postoperatively as well as refraining from the use of diuretics during and after intracranial meningioma surgery till the patient became fully ambulatory to reduce the incidence of postoperative VTE events.

New VTE Guidelines Favor NOACs Over Warfarin

New VTE Guidelines Favor NOACs Over Warfarin

Does use of compression stockings after deep vein thrombosis (DVT) improve outcomes?

Does use of compression stockings after deep vein thrombosis (DVT) improve outcomes?

The effects of short-term use of compression stockings on health related quality of life in patients with chronic venous insufficiency.

[Purpose] This study was aimed to analyse the effects of short-term use of compression stockings (CS) on symptoms and QoL in patients with Chronic Venous Insufficiency (CVI). [Subjects and Methods] Based on the CEAP classification C2 and C3, 117 patients with CVI were enrolled in this study. The participants were divided into two groups. The control group refused to use CS, however, was advised to do exercises and take skin care whereas the CS group used CS and performed exercise. The data were collected by using Nottingham Health Profile (NHP), Venous Insufficiency Epidemiological and Economic Study (VEINES-QoL/Sym) and Beck Depression Inventory (BDI) at baseline and after four weeks of treatment and compared within and in between groups. [Results] The comparison of pre- and post-treatment differences between groups was statistically significant for all parameters. In the study group, pre- and post-treatment scores for each parameter were significantly different. However, elevated scores in the control group suggested worsening of the illness. [Conclusion] This study established that short-term use of CS in patients with CVI significantly improved disease specific and general QoL by reducing venous symptoms. Further studies with larger sample size are necessary to confirm these findings.

Post-thrombotic syndrome in patients treated with rivaroxaban or enoxaparin/vitamin K antagonists for acute deep-vein thrombosis. A post-hoc analysis.

Post-thrombotic syndrome (PTS) is a common complication of deep-vein thrombosis (DVT). Poor quality treatment with vitamin K antagonists (VKA) is a risk factor for PTS. We hypothesised that treatment with the direct oral anticoagulant (DOAC) rivaroxaban may lower PTS incidence as compared to enoxaparin/VKA, as DOACs have a more stable pharmacologic profile than VKA. We performed a post-hoc subgroup analysis of the Einstein DVT trial (n=3449). Kaplan-Meier survival analysis was performed to compare the cumulative incidence of PTS between the rivaroxaban and enoxaparin/VKA groups. Hazard ratios (HR) and 95 % confidence intervals (CI) were calculated using Cox proportional hazards models. We included 336 patients with a mean age of 58 ± 16 years and a median follow-up after index DVT of 57 months (interquartile range 48-64). Of these, 162 (48 %) had been treated with rivaroxaban and 174 (52 %) with enoxaparin/VKA. The cumulative PTS incidence at 60 months follow-up was 29 % in the rivaroxaban group and 40 % in the enoxaparin/VKA group. After adjusting for age, gender, body mass index, previous VTE, ipsilateral recurrent DVT, extent of DVT, idiopathic DVT, duration of anticoagulant treatment, compliance to assigned study medication, elastic compression stocking use and active malignancy, the HR of PTS development for rivaroxaban was 0.76 (95 % CI: 0.51-1.13). In conclusion, treatment of acute DVT with rivaroxaban was associated with a numerically lower but statistically non-significant risk of PTS compared to enoxaparin/VKA treatment. The potential effect on reducing PTS deserves evaluation in a large randomised trial.

Risk Factors for Venous Ulcer Following ACUTE Venous Thromboembolism: Results from the Riete Registry

Background: Venous ulcer, the most serious consequence of chronic venous insufficiency (CVI), is associated with a high morbidity, impaired quality of life and high costs. To date, risk factors for venous ulcer after acute VTE have not been characterized.Objective: To identify independent predictors of venous ulcer development one year after an acute VTE event.Methods: Using data from the RIETE international registry, we analysed risk factors for venous ulcers in patients with an objectively confirmed symptomatic acute VTE (DVT and/or pulmonary embolism (PE)) and followed up for at least one year. During follow-up, signs and symptoms of CVI, occurrence of a venous ulcer in the leg ipsilateral to DVT or, in the absence of reported DVT, in any leg were reported by local investigators. Independent predictors of venous ulcers were assessed using a stepwise multivariable model.Results: Of the 34,144 patients included in the RIETE registry, 4,305 were recruited in centres participating in long-term (1 to 3 years) follow-up. Of these, 54% (n=2,337) underwent an assessment for CVI. After a mean (SD) follow-up of 383 (+/-575) days, 55% (n=1297) had signs or symptoms of CVI and 2.5% (n=59) had developed a venous ulcer. History of previous VTE (OR=4.4 [2.6 - 7.7], signs of venous insufficiency (i.e. leg varicosities) at time of VTE event (OR=2.3 [1.3 - 4.0]), diabetes (OR=2.0 [1.0 - 3.8]), obesity (OR=1.8 [1.1 - 3.2]) and male sex (OR=2.7 [1.5 - 4.9]) were independent predictors of an increased risk of venous ulcer. Conversely, older age, presence of an objectively confirmed DVT at study enrolment, anticoagulant duration (<1 vs. >1 year), anticoagulant type (extended low molecular weight heparin vs. vitamin K antagonist), or presence of vena cava filter had no significant impact on risk of venous ulcer.When restricting our analysis to the 1790 patients with objectively confirmed DVT only, results remained similar in magnitude. Proximal character of DVT was associated with a 30% non-significant increased risk of - unquestionable - post-thrombotic ulcer but the proportion of distal DVT was low in our population (11%).Conclusions: After an acute VTE event, history of VTE, pre-existing signs of CVI, male sex, diabetes and obesity independently influenced the risk of venous ulcer. VTE therapeutic management (neither duration nor drugs) did not appear to modify this risk. Our results suggest that clinicians should consider strategies aimed to prevent ulcers in high risk patients, such as preventing VTE recurrence, use of compression stockings in those with CVI and encouraging weight loss in obese patients. DisclosuresGalanaud:bayer: Membership on an entity's Board of Directors or advisory committees, Research Funding; Daichi: Membership on an entity's Board of Directors or advisory committees, Research Funding. Bertoletti:Daichi: Honoraria; bayer: Honoraria; BMS-Pfizer: Consultancy, Honoraria. Monreal:Bayer: Consultancy, Membership on an entity's Board of Directors or advisory committees; sanofi: Consultancy, Membership on an entity's Board of Directors or advisory committees; boehringer: Consultancy, Membership on an entity's Board of Directors or advisory committees; daichii: Consultancy, Membership on an entity's Board of Directors or advisory committees.

Temporary Inferior Vena Cava Filters: Indications, Retrieval Rates and Follow-Up Management at a Single Academic Institution

Objectives: This study assessed the safety and efficacy of cyanoacrylate glue embolization (CGE) for the treatment of refluxing varicose veins. Methods: A prospective registry was created starting January 2014 for all patients with refluxing varicose veins undergoing CGE at a single center. Neither tumescent anesthesia nor postinterventional compression stockings were incorporated into the treatment. All patients underwent clinical examination and duplex ultrasound evaluation at 2 and 6 months postprocedure. Results: CGE was performed in 67 patients or 103 extremities with 108 vein segments. Target vein segments included 82.4% (89 of 108) great saphenous veins, 12.0% (13 of 108) short saphenous veins, and 5.6% (6 of 108) accessory saphenous veins. The treated segment lengths had a range from 12 cm to 63 cm. Technical success, defined as complete closure of the refluxing vein immediately after the procedure diagnosed by duplex ultrasound, occurred in 100% (108 of 108) of vein segments. The procedure was well tolerated, with only 10.4% (7 of 67) of patients experiencing venospasm. Ultrasound results were available for 80.6% (54 of 67) and 46.3% (31 of 67) of patients at 2 and 6 months, respectively. Only one of 108 target vein segments demonstrated recanalization. The target vein segment occlusion rate at 6 months was 96.8% (30 of 31). No cellulitis or postprocedural paresthesia was reported. No serious adverse events, including deep vein thrombosis, occurred. Conclusions: CGE of refluxing varicose veins is safe and effective without the use of compression stockings or tumescent anesthesia at 6 months.

The use of compression stockings during a marathon competition to reduce exercise-induced muscle damage: are they really useful?

Case-control study; ecological study. To examine the efficacy of wearing compression stockings to prevent muscle damage and to maintain running performance during a marathon competition. Exercise-induced muscle damage has been identified as one of the main causes of the progressive decrease in running and muscular performance found during marathon races. Thirty-four experienced runners were pair-matched for age, anthropometric data, and best race time in the marathon, and randomly assigned to a control group (n = 17) of runners who wore conventional socks or to a group of runners who wore foot-to-knee graduated compression stockings (n = 17). Before and after the race, a sample of venous blood was obtained, and jump height and leg muscle power were measured during a countermovement jump. Serum myoglobin and creatine kinase concentrations were determined as blood markers of muscle fiber damage. Total race time was not different between the control group and the compression stockings group (210 ± 23 and 214 ± 22 minutes, respectively; P = .58). Between the control group and the compression stockings group, postrace reductions in leg muscle power (-19.8% ± 17.7% versus -24.8% ± 18.4%, respectively; P = .37) and jump height (-25.3% ± 14.1% versus -32.5% . 20.4%, respectively; P = .27) were similar. At the end of the race, there were no differences between the control group and the compression stockings group in serum myoglobin (568 ± 347 ng·mL(-1) versus 573 ± 270 ng·mL(-1), respectively; P = .97) and creatine kinase concentration (390 ± 166 U·L(-1) versus 487 ± 227 U·L(-1), respectively; P = .16). The use of compression stockings did not improve running pace and did not prevent exercise-induced muscle damage during the marathon. Wearing compression stockings during long-distance running events is an ineffective strategy to avoid the deleterious effects of muscle damage on running performance. Therapy, level 2b.

Prevention of venous thromboembolic complications with and without intermittent pneumatic compression in neurosurgical cranial procedures using intraoperative magnetic resonance imaging. A retrospective analysis

ObjectTo evaluate the introduction of intraoperative and postoperative pneumatic compression additionally to the use of compression stockings, low molecular weight heparin-LMWH and early mobilization, a retrospective study in cranial neurosurgery using intraoperative MRI was performed. MethodsA retrospective analysis of 207 neurosurgical patients using intraoperative MRI was performed. A group of 86 patients was treated with the additional use of intraoperative and postoperative pneumatic compression until mobilization out of bed. One hundred twenty-one patients were treated without the use of additional pneumatic compression. Postoperatively the patients were screened for deep venous thrombosis by ultrasound and pulmonary embolism by CT-scan if suspicious. Statistical analysis was performed. ResultsThe development of deep venous thrombosis was reduced from 9.9% to 3.5% in our patients with the additional use of intraoperative and postoperative pneumatic compression. That is a 64.6% relative risk reduction to develop deep venous thrombosis with the use of intraoperative and postoperative pneumatic compression.An additional 52% relative risk reduction was found for the chance of developing pulmonary embolism.In the 15 patients with detected deep venous thrombosis, the OR-time was more than 100min longer than in the 192 patients without detected deep venous thrombosis. The difference between both groups was significant. ConclusionThis study demonstrates the benefit of pneumatic compression with a risk reduction for the development of thromboembolic complications. OR-time is another risk factor that attributes to a significant risk for the development of thromboembolic complications.

Use of Compression Stockings in Chronic Venous Disease: Validation of a New Device to Assess Patient Compliance.

Use of Compression Stockings in Chronic Venous Disease: Validation of a New Device to Assess Patient Compliance.

Therapeutic use of compression stockings for orthostatic hypotension: an assessment of patient and physician perspectives and practices.

Elastic compression stockings (ECS) can be used as a non-pharmacological therapeutic option for older patients with orthostatic hypotension (OH). We aimed to investigate the practices and views of patients and physicians regarding the use of ECS for OH. Two surveys were designed. The first was sent to 90 patients known to have been prescribed ECS for OH. This questionnaire included items related to the frequency of use and issues related to non-compliance. The second was sent to 69 consultant physicians in geriatric medicine. This included items related to prescribing practices and perceived patient compliance. Sixty-seven patients responded (response rate, 74%) and of those 64% were female. Mean age (SD) was 75.1 years (10.5), range 45-91 years. Thirty-three per cent wore ECS daily, whereas 43% never used them. Over half (51%) of the patients reported difficulty in application and 31% reported discomfort. Those aged 75 or older were more likely to report difficulty in application (P=0.003). Forty-eight physicians responded (response rate, 70%). Eighty-nine per cent prescribe ECS for OH. There were significant differences between the frequency of use reported by patients and predicted by physicians (P<0.001), with physicians less likely to predict daily or non-use. Eighty-nine per cent of physicians predicted that difficulty in application was the main reason for non-compliance. Although prescribed frequently, the use of ECS in patients with OH is often limited by issues related to practicality. Physicians correctly predicted the main reasons for non-compliance although underestimated the scale of patient compliance with ECS.

Traditions and myths in hip and knee arthroplasty

Background and purpose — Traditions are passed on from experienced surgeons to younger fellows and become “the right way to do it”. Traditions associated with arthroplasty surgery may, however, not be evidence-based and may be potentially deleterious to both patients and society, increasing morbidity and mortality, slowing early functional recovery, and increasing cost.Methods — We identified selected traditions and performed a literature search using relevant search criteria (June 2014). We present a narrative review grading the studies according to evidence, and we suggest some lines of future research.Results — We present traditions and evaluate them against the published evidence. Preoperative removal of hair, urine testing for bacteria, use of plastic adhesive drapes intraoperatively, and prewarming of the operation room should be abandoned—as should use of a tourniquet, a space suit, a urinary catheter, and closure of the knee in extension. The safety and efficacy of tranexamic acid is supported by meta-analyses. Postoperatively, there is no evidence to support postponement of showering or postponement of changing of dressings to after 48 h. There is no evidence to recommend routine dental antibiotic prophylaxis, continuous passive motion (CPM), the use of compression stockings, cooling for pain control or reduction of swelling, flexion of at least 90 degrees as a discharge criterion following TKA, or having restrictions after THA. We present evidence supporting the use of NSAIDs, early mobilization, allowing early travel, and a low hemoglobin trigger for transfusion.Interpretation — Revision of traditions and myths surrounding hip and knee arthroplasty towards more contemporary evidence-based principles can be expected to improve early functional recovery, thus reducing morbidity, mortality, and costs.

Compression – from thrombosis to post-thrombotic syndrome

ZusammenfassungEinleitung: Die Empfehlung von Kompression und Mobilisierung im akuten Stadium einer Thrombose, zusammen mit exakter Antikoagulation, beruht vorwiegend auf Erfahrung. Schwerpunktmäßig konzentrieren sich die meisten Therapie-Studien auf das Schicksal der Thromben. Einige randomisierte Vergleichsstudien konnten zeigen, dass ein derartiges Therapieregime nicht mit einer erhöhten Rate von Lungenembolien einhergeht.Methode: Die Literatur wurde hinsichtlich der Fragestellung überprüft.Ergebnisse: Subjektive Beschwerden des Patienten wurden bisher nur in einzelnen randomisiert- kontrollierten Studien untersucht, die eine Verminderung von Schmerz und Schwellung sowie eine Verbesserung der Lebensqualität zeigten. Damit wurde das Therapieprinzip Antikoagulation, Kompression und Mobilisierung zum Kern der ambulanten Thrombosetherapie.Nach der bisher vorliegenden Evidenzlage kann eine Weiterführung der Kompression über zwei Jahre die Häufigkeit eines post-thrombotischen Syndroms signifikant reduzieren. Die Empfehlung einer Kompressionsstrumpf-Versorgung nach Thrombose, die sich auch in einschlägigen Leitlinien findet, wurde durch eine rezente kanadisch-amerikanische Multicenterstudie in Frage gestellt. In dieser Studie wurden bei Patienten mit proximaler Erstthrombose der Effekt von 30–40 mmHg-Strümpfen gegenüber jenem von „Placebo-Strümpfen“ (5 mmHg) vergli-chen. Bis zu zwei Jahren fand sich kein Unterschied zwischen beiden Gruppen, weder nach den Ginsberg-Kriterien (Schmerz und Schwellung länger als ein Monat), noch nach der Villalta-Skala (Summenscore aus subjektiven Beschwerden und klinischen Zeichen). Die Strümpfe wurden den Patienten per Post geschickt, mehr als die Hälfte der Patienten war letztlich nicht im Stande zu beurteilen, ob sie einen Therapiestrumpf oder ein Placebo bekommen hatten. Jene 55 % der Patienten, welche nach eigenen Angaben ihre Strümpfe mehr als 3 Tage pro Woche trugen, wurden als „frequent users“ eingestuft. Neben mehreren anderen Problemen mit dieser Studie bleibt die Frage offen, wie in einer „kontrollieren Studie“ ein Therapieeffekt einer Maßnahme beurteilt werden kann, die offenbar nur sporadisch angewendet wurde.Schlussfolgerung: Der anti-inflammatorische Effekt einer guten Kompressionstherapie in Form einer Reduktion von Schmerz und Schwellung der Thromboseextremität im akuten Stadium sollte durch weitere Kompressionsbestrumpfung für einige Monate aufrecht erhalten und das weitere Procedere dann vorwiegend nach klinischen Kriterien entschieden werden. Weitere Verlaufsstudien, welche die Rolle der Kompression auf die klinische Symptomatik von der Thrombose zum postthrombotischen Syndrom untersuchen, sind zu empfehlen.

İZOLE VENA SAFENA PARVA STRİPİNGİ SONRASINDA KOMPRESYON ÇORAPLARININ ETKİNLİĞİ: RETROSPEKTİF ÇALIŞMA

Background: The objective of this study is to investigate the effectiveness of medium pressurized elastic compression stockings usage after isolated vena saphena parva stripping. Material and Methods: Between 2001 January2014 March, 60 patients (40 women, 20 men, mean age; 39± 11 years, 35 to 58 years range) treated with vena saphena parva ligation and total stripping for isolated vena saphena parva insufficiency, were enrolled in this retrospective study. Elastic bandage applied postoperatively. Patients were divided into two groups according to use of additional compression stocking for 4 weeks; as stockings using group, (group 1; 18 women, 12 men, mean age 35±12.2, 23 to 47 years) and as no stockings using group, (group 2; 22 women, 8 men, mean age 38±10.8, 27 to 49 years) and. Primary outcomes and secondary outcomes were evaluated. Results: Extremity volumes in Group 1 and Group 2 were reduced from preoperatively 4600±540 ml and 4740 ± 420 ml to postoperatively 4440±430 ml and 4660 ± 400 ml, respectively. There were no differences between two groups by means of time to return to work and complications. Extremity volumes and Visual Analogue Scale pain scores were detected statistically significant reduction at the end of 4 weeks in group 1. Conclusion: Additional use of compression stockings after isolated vena saphena parva stripping can provide significant reduction in extremity edema and visual analog scale pain score. On the other hand, developing complications and time to return to work in both groups seem similar

Multidisciplinary initiative to improve inpatient anticoagulation and management of venous thromboembolism

The implementation of best practices to optimize inpatient anticoagulation and venous thromboembolism (VTE) management are described. A multidisciplinary team of pharmacists, hospitalists, computer prescriber-order-entry system (CPOE) experts, and data specialists was assembled. A VTE management best-practices bundle was designed and implemented using education, CPOE upgrades, clinical decision support, triggered consultation, and checklists. Process performance data were collected from CPOE and chart review. A total of 189 patients with 211 identified VTE events were included in the analysis. Compliance with warfarin adjustment by protocol improved significantly, from 70% before the launch of the order set to 96% afterward. Heparin-warfarin overlap nearly tripled, from 26% to 74%, but still over a quarter of postimplementation cases did not meet this quality measure. While low-molecular-weight heparin (LMWH) was used appropriately in all six postintervention cases of cancer-related VTE, the result was not a significant improvement over the 68% compliance in the period preceding the order set. The prescription rate of compression stockings after leg DVT was low in both periods. Point estimates for mean length of hospital stay improved but did not reach statistical significance. Measures of mortality and readmission rates were limited by sample size and were not significantly changed. Implementation by a multidisciplinary team of a VTE management bundle incorporated CPOE upgrades and other interventions. Laboratory testing before warfarin treatment, warfarin education, warfarin adjustment by protocol, and warfarin-heparin overlap improved after the interventions, but LMWH education, compression stocking use, laboratory testing before heparin treatment, and clinical outcomes did not change significantly.

An active compression bandage based on shape memory alloys: a preliminary investigation.

BackgroundDisorders associated with excessive swelling of the lower extremities are common. They can be associated with pain, varicose veins, reduced blood pressure when standing and may cause syncope or fainting. The common physical remedy to these disorders is the use of compression stockings and pneumatic compression leg massagers, which both attempt to limit blood pooling and capillary filtration in the lower limbs. However, compression stockings provide a constant pressure, and their efficiency has been challenged according to some recent studies. Air compression leg massagers on the other hand, restricts patient mobility. In this work we therefore present an innovative active compression bandage based on the use of a smart materials technology that could produce intermittent active pressure to mitigate the symptoms of lower extremity disorders.MethodsAn active compression bandage (ACB), actuated by shape memory alloy (SMA) wires, was designed and prototyped. The ACB was wrapped around a calf model to apply an initial pressure comparable to the one exerted by commercial compression stockings. The ACB was controlled to apply different values of compression. A data acquisition board and a LabVIEW program were used to acquire both the pressure data exerted by the ACB and the electrical current required to actuate the SMA wires. An analytical model of the ACB based on a SMA constitutive model was developed. An optimizer was implemented to identify optimal parameters of the model to best estimate the performance of the ACB.ResultsThe maximum increase in pressure due to the SMA wires activation was 40.8% higher than the initially applied pressure to the calf model. The analytical model of the ACB estimated the behaviour of the ACB with less than 0.32 mmHg difference with the experimental results.ConclusionsThe prototyped ACB was able to apply an initial compression comparable to the one applied by commercial compression stockings. Activation of the ACB resulted in an increase of compression up to 9.06 mmHg. Comparison between analytical and experimental results showed the analytical model was suitable to predict the behaviour of the ACB.

The Role of Obesity and Obstructive Sleep Apnea in the Pathogenesis and Treatment of Resistant Hypertension

The incidence of resistant hypertension, obesity, and obstructive sleep apnea (OSA), three highly prevalent conditions in the United States, is rising. Approximately one in three adults in the US has hypertension, and a significant proportion of these individuals have hypertension that is difficult to treat, or resistant. Obesity and OSA are well-established risk factors for resistant hypertension, a condition that portends significant cardiovascular risk. Awareness of the various mechanisms by which obesity and OSA impact systemic blood pressure is essential to better understand how best to effectively care for patients with resistant hypertension. In this review, we discuss the clinical and pathophysiologic associations between obesity, OSA, and resistant hypertension. Furthermore, we will explore the effect of continuous positive airway pressure therapy (CPAP) and other therapeutic interventions on blood pressure control in patients with resistant hypertension.Key Points• Obesity, obstructive sleep apnea, and resistant hypertension are highly prevalent conditions, with increasing overall incidence [1-3].• Both obesity and obstructive sleep apnea are independent risk factors for the development of resistant hypertension.• OSA is characterized by a physiologic cascade of collapse of the upper airway, which can lead to intermittent hypoxia, hypercapnia, significant negative intra-thoracic pressure, and increased SNS output.• Intermittent hypoxia leads to activation of the endothelin system [17, 18, 19•], which can lead to the development of resistant hypertension.• Intermittent hypoxia can lead to the over activation of the SNS, which can also contribute to the development of resistant hypertension [20, 21].• OSA leads to state of elevated adrenergic tone, which in turn may contribute to resistant hypertension [25-27].• OSA patients have a higher incidence of "non-dipping" of nocturnal systolic blood pressure, a marker of increased adrenergic tone. This potentially represents a risk factor for hypertensive end organ disease [31, 32].• The prevalence of OSA is significantly higher in patients predisposed to fluid accumulation: including kidney disease, heart failure and resistant hypertension [33].• Interventions (such as the daytime use of compression stocking) which reduce daytime lower extremity fluid accumulation can significantly reduce the severity of OSA, particularly in patients with comorbid resistant hypertension [35, 36].• CPAP therapy can significantly reduce blood pressure in patients with comorbid hypertension and OSA. The treatment effect is most pronounced in those with resistant hypertension and OSA [16••, 38-42].

Compression stockings for the initial treatment of varicose veins in patients without venous ulceration

Compression hosiery or stockings are often the first line of treatment for varicose veins in people without either healed or active venous ulceration. Evidence is required to determine whether the use of compression stockings can effectively manage and treat varicose veins in the early stages. This is an update of a review first published in 2011. To assess the effectiveness of compression stockings for the only and initial treatment of varicose veins in patients without healed or active venous ulceration. For this update the Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched August 2013) and CENTRAL (2013, Issue 5). Randomised controlled trials (RCTs) were included if they involved participants diagnosed with primary trunk varicose veins without healed or active venous ulceration (Clinical, Etiology, Anatomy, Pathophysiology (CEAP) classification C2 to C4). Included trials assessed compression stockings versus no treatment, compression versus placebo stockings, or compression stockings plus drug intervention versus drug intervention alone. Trials comparing different lengths and pressures of stockings were also included. Trials involving other types of treatment for varicose veins (either as a comparator to stockings or as an initial non-randomised treatment), including sclerotherapy and surgery, were excluded. Two authors assessed the trials for inclusion and quality (SS and LR). SS extracted the data, which were checked by LR. Attempts were made to contact trial authors where missing or unclear data were present. Seven studies involving 356 participants with varicose veins without healed or active venous ulceration were included. Different levels of pressure were exerted by the stockings in the studies, ranging from 10 to 50 mmHg. One study assessed compression hosiery versus no compression hosiery. The other six compared different types or pressures of stockings. The methodological quality of all included trials was unclear, mainly because of inadequate reporting.The symptoms subjectively improved with the wearing of stockings across trials that assessed this outcome, but these assessments were not made by comparing one randomised arm of a trial with a control arm and are therefore subject to bias.Meta-analyses were not undertaken due to inadequate reporting and actual or suspected high levels of heterogeneity. There is insufficient, high quality evidence to determine whether or not compression stockings are effective as the sole and initial treatment of varicose veins in people without healed or active venous ulceration, or whether any type of stocking is superior to any other type. Future research should consist of a large RCT of participants with trunk varices either wearing or not wearing compression stockings to assess the efficacy of this intervention. If compression stockings are found to be beneficial, further studies assessing which length and pressure is the most efficacious could then take place.

Compression stockings to prevent post-thrombotic syndrome: a randomised placebo-controlled trial

Post-thrombotic syndrome (PTS) is a common and burdensome complication of deep venous thrombosis (DVT). Previous trials suggesting benefit of elastic compression stockings (ECS) to prevent PTS were small, single-centre studies without placebo control. We aimed to assess the efficacy of ECS, compared with placebo stockings, for the prevention of PTS. We did a multicentre randomised placebo-controlled trial of active versus placebo ECS used for 2 years to prevent PTS after a first proximal DVT in centres in Canada and the USA. Patients were randomly assigned to study groups with a web-based randomisation system. Patients presenting with a first symptomatic, proximal DVT were potentially eligible to participate. They were excluded if the use of compression stockings was contraindicated, they had an expected lifespan of less than 6 months, geographical inaccessibility precluded return for follow-up visits, they were unable to apply stockings, or they received thrombolytic therapy for the initial treatment of acute DVT. The primary outcome was PTS diagnosed at 6 months or later using Ginsberg's criteria (leg pain and swelling of ≥1 month duration). We used a modified intention to treat Cox regression analysis, supplemented by a prespecified per-protocol analysis of patients who reported frequent use of their allocated treatment. This study is registered with ClinicalTrials.gov, number NCT00143598, and Current Controlled Trials, number ISRCTN71334751. From 2004 to 2010, 410 patients were randomly assigned to receive active ECS and 396 placebo ECS. The cumulative incidence of PTS was 14·2% in active ECS versus 12·7% in placebo ECS (hazard ratio adjusted for centre 1·13, 95% CI 0·73-1·76; p=0·58). Results were similar in a prespecified per-protocol analysis of patients who reported frequent use of stockings. ECS did not prevent PTS after a first proximal DVT, hence our findings do not support routine wearing of ECS after DVT. Canadian Institutes of Health Research.