The effect of graduated compression stockings on blood velocity in the deep venous system of the lower limb in the postnatal period

AbstractObjectivesTo investigate whether the use of graduated compression stockings (GCS) offers any adjuvant benefit when pharmaco-thromboprophylaxis is used for venous thromboembolism prophylaxis in patients undergoing elective surgery.DesignOpen, multicentre, randomised, controlled, non-inferiority trial.SettingSeven National Health Service tertiary hospitals in the United Kingdom.Participants1905 elective surgical inpatients (≥18 years) assessed as being at moderate or high risk of venous thromboembolism were eligible and consented to participate.InterventionParticipants were randomly assigned (1:1) to receive low molecular weight heparin (LMWH) pharmaco-thromboprophylaxis alone or LMWH pharmaco-thromboprophylaxis and GCS.Outcome measuresThe primary outcome was imaging confirmed lower limb deep vein thrombosis with or without symptoms, or pulmonary embolism with symptoms within 90 days of surgery. Secondary outcome measures were quality of life, compliance with stockings and LMWH, lower limb complications related to GCS, bleeding complications, adverse reactions to LMWH, and all cause mortality.ResultsBetween May 2016 and January 2019, 1905 participants were randomised. 1858 were included in the intention to treat analysis (17 were identified as ineligible after randomisation and 30 did not undergo surgery). A primary outcome event occurred in 16 of 937 (1.7%) patients in the LMWH alone group compared with 13 of 921 (1.4%) in the LMWH and GCS group. The risk difference between the two groups was 0.30% (95% confidence interval −0.65% to 1.26%). Because the 95% confidence interval did not cross the non-inferiority margin of 3.5% (P<0.001 for non-inferiority), LMWH alone was confirmed to be non-inferior.ConclusionsFor patients who have elective surgery and are at moderate or high risk of venous thromboembolism, administration of pharmaco-thromboprophylaxis alone is non-inferior to a combination of pharmaco-thromboprophylaxis and GCS. These findings indicate that GCS might be unnecessary in most patients undergoing elective surgery.Trial registrationISRCTN13911492.

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Foot or hand malformations related to deep venous system anomalies of the lower limb in Klippel-Trénaunay syndrome

Journal of the American Academy of Dermatology ◽

10.1016/j.jaad.2009.04.027 ◽

2009 ◽

Vol 61 (4) ◽

pp. 621-628 ◽

Cited By ~ 14

Author(s):

Pedro Redondo ◽

Gorka Bastarrika ◽

Leyre Aguado ◽

Antonio Martínez-Cuesta ◽

Alejandro Sierra ◽

...

Keyword(s):

Lower Limb ◽

Venous System ◽

Deep Venous System ◽

Klippel Trenaunay Syndrome

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AN UNUSUAL ANOMALY OF DEEP VENOUS SYSTEM IN THE LOWER LIMB: COMPLETE UNILATERAL AGENESIS OF ILIOFEMORAL VEINS IN THE ABSENCE OF PERSISTENT SCIATIC VEIN

Indian Journal of Case Reports ◽

10.32677/ijcr.2019.v05.i02.022 ◽

2019 ◽

Vol 5 (2) ◽

pp. 161-164

Author(s):

Venkatram Krishnan ◽

Puneet Garg ◽

Abhilash Sethy ◽

Rohini Gupta

Keyword(s):

Lower Limb ◽

Venous System ◽

Deep Venous System

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Compression therapy and pressure in the deep venous system

Phlebology The Journal of Venous Disease ◽

10.1258/026835503322598018 ◽

2003 ◽

Vol 18 (4) ◽

pp. 192-197 ◽

Cited By ~ 1

Author(s):

J C J M Veraart ◽

T K Oei ◽

H A M Neumann

Keyword(s):

Venous Insufficiency ◽

Venous Pressure ◽

Venous System ◽

Rank Test ◽

Class Iii ◽

Compression Stockings ◽

Elastic Compression ◽

Deep Venous System ◽

Strong Compression ◽

Elastic Stockings

Objectives: To evaluate the effect of five different elastic compression stockings on the venous pressure in the deep venous system in the supine and standing positions. Methods: Setting: Departments of Dermatology and Radiology, University Hospital Maastricht, The Netherlands. Patients: A total of eight limbs of seven subjects (five patients and two healthy volunteers) with a mean age of 53 years (range 33-79) were measured. The patients were known to have severe venous insufficiency and recurrent leg ulceration. A catheter connected to an external pressure transducer was placed in one of the deep veins of the lower leg after puncturing the popliteal vein. The position of the catheter was established with contrast medium. Venous pressure recordings were made in the supine and standing positions while wearing an anti-embolism stocking and while wearing four different compression stockings (class II and III). Results: All stockings worn in the supine position caused a significant increase in pressure when compared with no compression at all ( P <0.05; Wilcoxon rank test). Only the strong compression class III stockings caused a significant and clinically relevant pressure increase, compared with the other four elastic compression stockings ( P <0.05; Wilcoxon rank test). In the standing position no differences in pressure were found between the elastic stockings, or when any stocking was compared with the use of no stocking at all. Conclusions: The results demonstrate that only strong compression class III stockings (>40 mmHg at the ankle) increase the pressure in the deep venous system in the supine position. Because of this, these elastic stockings may be the only stockings that have a positive influence on the pathologic deep venous system in patients with deep venous insufficiency, such as after deep venous thrombosis. The study confirms earlier clinical observations that in the treatment of patients with post-thrombotic symptoms and deep venous insufficiency only strong elastic compression stockings are effective.

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Effect of graduated compression stockings on venous lower limb hemodynamics in healthy amateur runners

Journal of Vascular Surgery Venous and Lymphatic Disorders ◽

10.1016/j.jvsv.2017.08.011 ◽

2018 ◽

Vol 6 (1) ◽

pp. 83-89 ◽

Cited By ~ 6

Author(s):

Oswaldo Teno Castilho Junior ◽

Nei Rodrigues Alves Dezotti ◽

Marcelo Bellini Dalio ◽

Edwaldo Edner Joviliano ◽

Carlos Eli Piccinato

Keyword(s):

Lower Limb ◽

Compression Stockings ◽

Graduated Compression Stockings

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Effects of graduated compression stockings, local vibration and their combination on popliteal venous blood velocity

Phlebology The Journal of Venous Disease ◽

10.1177/0268355520902000 ◽

2020 ◽

Vol 35 (7) ◽

pp. 505-512

Author(s):

Loïc Espeit ◽

Thomas Lapole

Keyword(s):

Pilot Study ◽

Prone Position ◽

Doppler Ultrasound ◽

Healthy Subjects ◽

Peak Velocity ◽

Venous Blood ◽

Blood Velocity ◽

Compression Stockings ◽

Local Vibration ◽

Graduated Compression Stockings

Objectives The purpose of this pilot study was to examine and compare the effects of graduated compression stockings, local vibration, and combined graduated compression stockings and local vibration on popliteal venous blood velocity. Method Twenty-four healthy subjects received four 15 min interventions (control, graduated compression stockings alone, local vibration alone, and combined graduated compression stockings and local vibration), while resting inactive in the prone position. Popliteal vein blood velocity was investigated before (PRE) and at the end (POST) of each intervention using Doppler ultrasound. Results At POST, peak velocity was reported to be 26.3 ± 53.5% ( p < 0.05) greater for local vibration than control (CONT). Peak velocity was 46.2 ± 54.6% ( p < 0.001) and 21.1 ± 37.6% ( p < 0.01) higher for graduated compression stockings than CONT and local vibration, respectively. Graduated compression stockings + local vibration presented 64.1 ± 58.0% ( p < 0.001), 38.4 ± 52.4% ( p < 0.001) and 15.0 ± 31.6% ( p < 0.05) greater values than CONT, local vibration and graduated compression stockings, respectively. Conclusions This study demonstrated an increase in popliteal venous blood velocity after graduated compression stockings and local vibration application. Their combination provided the greatest effects.

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Variations in Lower Limb Deep Venous Anatomy in Latvia

Acta Chirurgica Latviensis ◽

10.2478/chilat-2013-0010 ◽

2013 ◽

Vol 13 (1) ◽

pp. 51-56 ◽

Cited By ~ 1

Author(s):

Dainis Krievins ◽

Regina Zarina R ◽

Janis Savlovskis ◽

Polina Dombure

Keyword(s):

Retrospective Analysis ◽

Lower Limb ◽

Femoral Vein ◽

Iliac Vein ◽

Venous System ◽

Lower Limbs ◽

Anatomic Variations ◽

Deep Venous System ◽

Data Comparison ◽

Parametric Data

Summary Introduction. During the last several decades there have been many new methods introduced for the treatment of lower limb chronic venous insufficiency (laser, foam, subendothelial and thermal coagulation methods). Venous system of lower limbs often presents anatomic variations including venous duplications. Knowledge of venous system variations in the lower limb area is of particular importance due to correct interpretation of imaging in relation to deep vein thrombosis (DVT). There was only a small number of studies published on anatomic variations of venous system in the lower limbs. To the best of our knowledge there have been no previous studies on anatomic variations of lower limb deep venous system performed in Latvia. Aim of the study. To retrospectively review of 216 patients (432 lower limbs) phlebograms in order to establish deep venous system anatomic variations in Latvian population and compare our results to other publications. Materials and methods. Retrospective analysis of 432 lower limb phlebograms performed at Pauls Stradins Clinical University Hospital (Riga, Latvia) of 216 patients treated in different ortopedic centers of Latvia during 2009 and 2012. Assessment made using DICOM Synedra view personal software. Study protocol was developed for definition of veins and assessment of phlebogram images in accordance with anatomic definitions used in previous studies. Two independent radiologists assessed data. Visualised duplications in the deep venous system of both lower limbs in patients were registered (common iliac vein, external iliac vein, common femoral vein, femoral vein, deep femoral vein, popliteal vein). Blood vessels have been listed as single, double or triple / complex. The presence of DVT was recorded upon assessment of phlebograms. Statistical analysis performed using SPSS 20.0 software (IBM). Parametric data comparison performed using Student t-test and ANOVA. Non-parametric data comparison performed using chi-square and Mann Whitney tests. Data comparison type was assessed using Kolmogorova-Smirnovs test. The results are presented as the average ± standard deviation. Results. Retrospective analysis of 432 lower limb phlebograms was performed in 216 patients. Average age of the patients was 34.4 years (range 19-90). 101 patients were female (47%) and 115 (53%) were male with no statistical venous variation differences found between two genders, which is explained by both age and gender (p > 0.05). Analysis of calf vein, popliteal vein and femoral venous variations provided a strong correlation between larger number of duplications in one limb and possibility of such variations in the other limb of the same patient (all p < 0.001). Conclusion. We conclude that there are frequent anatomic variations in SFV and popliteal veins seen in Latvian population. All patients included in this study had high DVT risk, much higher than in the average Latvian population. In almost every sixth Latvian person there is some form of deep veins hypoplasia found.

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The Effect of Graduated Compression Stockings on Lower Limb Venous Haemodynamics

Phlebology The Journal of Venous Disease ◽

10.1177/026835559601100403 ◽

1996 ◽

Vol 11 (4) ◽

pp. 141-145 ◽

Cited By ~ 12

Author(s):

E. A. Cooke ◽

T. Benkö ◽

B. M. O'Connell ◽

M. A. McNally ◽

R. A. B. Mollan

Keyword(s):

Lower Limb ◽

Bed Rest ◽

Venous Stasis ◽

Controlled Study ◽

Control Group ◽

Venous Blood Flow ◽

Compression Stockings ◽

Venous Outflow ◽

Venous Capacitance ◽

Graduated Compression Stockings

Objectives: To compare the effect of four types of thigh-length graduated compression stockings (GCS) on lower limb venous blood flow using strain-gauge Plethysmography (SGP). Design: A randomized controlled study. Setting: Inpatient Orthopaedic Centre. Patients: 200 preoperative patients admitted for elective lower limb orthopaedic surgery. Interventions: Patients were randomized to five groups to wear one of four types of GCS or no stocking (control). Resting venous flow parameters were measured prior to application of GCS and after 20 min bed rest with the stockings in situ. Main outcome measures: Effects on resting venous capacitance (Vc) and venous outflow (Vo). Results: In the control group 20 min bed rest had no effect on the parameters studied. Both Vc and Vo were significantly increased ( p<0.001) in all the groups wearing stockings. There was a significant variation in the changes in outflow produced by the different stocking types ( p<0.05). Conclusions: GCS have a beneficial effect on lower limb venous outflow, preventing venous stasis, an important factor in the development of deep venous thrombosis. This effect varies depending on which type of stocking is used.

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