Compression therapy and pressure in the deep venous system

2003 ◽  
Vol 18 (4) ◽  
pp. 192-197 ◽  
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.

scholarly journals Elastic compression treatment of chronic superficial venous insufficiency of the lower limbs based on Doppler venous pressure index measurements

2015 ◽  
Vol 4 (1) ◽  
Author(s):  
Leonardo Corcos ◽  
Daniele Pontello ◽  
Tommaso Spina
Keyword(s):  
Venous Insufficiency ◽  
Varicose Veins ◽  
Venous Pressure ◽  
Lower Limbs ◽  
Compression Stockings ◽  
Elastic Compression ◽  
Pressure Index ◽  
Counter Pressure ◽  
The Difference ◽  
Compression Treatment

Ineffectiveness or discomfort from graduated elastic compression stockings (GES) in patients with chronic venous insufficiency (CVI) and/or varicose veins of the lower limbs (VVLL) can depend of inappropriate counter pressure applied. Counter pressure was calculated by Doppler venous pressure index (VPI). The aim of this study was to verify the value VPI in the choice of GES. A total of 1212 LL of 606 patients subjected to VPI measurements VPI correlated with the various sites of reflux (R) and C of Clinical-Etiology-Anatomy-Pathophysiology (CEAP) classification. The difference between standing VPI the and normal values=counter pressure to be applied by GES. Questionnaire to 96 patients with CVI/VVLL wearing GES. Mean VPI values: greater saphenous (GSV)&gt;smaller saphenous; GSV with isolated venous reflux (R) at the leg&gt;GSV at the thigh; additional R in perforators increases VPI in all the districts; superficial R increases VPI in PT. Relation between VPI/C of CEAP: P&lt;0.05-0.0001; 81/83/96 (97.5%) patients improved; 0 complained. R in GSV at the leg and in perforators increases VPI in deep veins. Few discrepancies VPI/CEAP can be expected. Standing VPI is highly predictive. The best choice of GES can be based on the VPI measurement.

The Effect of Elastic Compression on Calf Muscle Pump Function

1990 ◽  
Vol 5 (1) ◽  
pp. 13-19 ◽  
Author(s):  
D. Christopoulos ◽  
A. N. Nicolaides ◽  
G. Belcaro ◽  
P. Duffy
Keyword(s):  
Venous Pressure ◽  
Haemodynamic Effect ◽  
Calf Muscle ◽  
Venous Reflux ◽  
Venous Capacitance ◽  
Elastic Compression ◽  
Muscle Pump ◽  
Calf Muscle Pump ◽  
Elastic Stockings ◽  
Venous Volume

The haemodynamic effect of elastic compression has been evaluated in 23 patients (26 limbs) with superficial venous incompetence. Ambulatory venous pressure (AVP) and pressure recovery time (RT90) were measured with foot vein canulation. Also the functional venous volume (VV) (venous capacitance), venous reflux and the ejecting capacity of the calf muscle pump were measured with air-plethysmography. The above measurements were made with and without a graduated compression elastic stocking. Elastic compression produced a significant reduction in VV ( P < 0.01). Also a significant decrease in venous reflux and increase in the ejecting capacity of the calf muscle pump ( P < 0.01). The above alterations explain the significant reduction in AVP and prolongation of RT90 ( P < 0.01) which was observed as a result of elastic compression. The measurements made in this study demonstrate in an objective and quantitative way the beneficial effect of elastic stockings in patients with superficial venous incompetence and how this effect is achieved.

scholarly journals Synergistic Effect of Adjustments of Elastic Stockings to Maintain Reduction in Leg Volume after Mechanical Lymph Drainage

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
José Maria Pereira de Godoy ◽  
Renata Lopes Pinto ◽  
Ana Carolina Pereira de Godoy ◽  
Maria de Fátima Guerreiro Godoy
Keyword(s):  
Clinical Trial ◽  
Synergistic Effect ◽  
Randomized Clinical Trial ◽  
Compression Stockings ◽  
Lymph Drainage ◽  
Elastic Compression ◽  
Elastic Stockings ◽  
Grade Ii

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

Effect of Graduated Compression Stockings on Limb Oxygenation and Venous Function during Exercise in Patients with Venous Insufficiency

Vascular ◽  
2004 ◽  
Vol 12 (1) ◽  
pp. 69-76 ◽  
Author(s):  
Obi Agu ◽  
Daryll Baker ◽  
Alexander M. Seifalian
Keyword(s):  
Supine Position ◽  
Venous Insufficiency ◽  
Oxygenation Index ◽  
Muscle Oxygenation ◽  
Class I ◽  
Class Iii ◽  
Compression Stockings ◽  
Venous Function ◽  
Graduated Compression Stockings ◽  
Hb Concentration

Despite the established role of compression as the basis for nonoperative treatment of chronic venous insufficiency (CVI), its mechanism of action remains unclear. Near-infrared spectroscopy (NIRS) provides continuous noninvasive monitoring of changes in tissue oxyhemoglobin (HbO2) and deoxyhemoglobin (Hb). We applied NIRS to evaluate the effect of graded stockings on venous function and calf muscle oxygenation during exercise in patients with CVI. Ten patients (age 56 ± 5 years) with CVI were rested in supine posture for 20 minutes. NIRS optodes were attached to the calf. Venous function was assessed in each patient with and without graded compression stockings (classes I to III) at rest in the supine position, standing, with 10 tiptoe exercises, and on standard walking at 1.6 km/h for 5 minutes. Venous function was assessed by measuring changes in Hb and total hemoglobin (HbT) during the test, and muscle oxygenation was assessed by the oxygenation index (HbD), which is the difference between HbO2 and Hb. Standing without stockings caused a significant increase in Hb concentration by 10.75 ± 2.24 µmol/L compared with the supine position ( p < .001). This value was reduced when stockings were applied to 6.38 ± 2.75 µmol/L with class III stockings ( p = .005). During tiptoe exercise, the residual Hb concentration value without stockings was 7.62 ± 2.12 µmol/L compared with 5.88 ± 2.87, 3.77 ± 3.37, and 3.46 ± 2.73 ±mol/L for class I, II, and III stockings, respectively. The reduction in Hb concentration reached significance with class II and III stockings compared to without stockings ( p = .04). The HbT concentration was also reduced during tiptoe exercise, with increasing compression from 15.46 ± 5.31 µmol/L without compression to 11.52 ± 4.26 µmol/L with class III stockings ( p = .048). During walking, the Hb concentration was 11.40 ± 3.10 µmol/L without stockings, decreasing significantly ( p < .001) and progressively to 8.49 ± 3.24, 7.71 ± 3.51, and 6.89 ± 3.16 µmol/L with class I, II, and III stockings, respectively. Limb oxygenation (as measured by HbO2 concentration) during walking exercise, however, increased with higher-compression stockings and reached significance with class III stockings only ( p = .03). In patients with venous insufficiency, graduated compression stockings may achieve their beneficial effects by reducing venous pooling and improving deeper tissue oxygenation.

scholarly journals Reduction of Pain and Edema of the Legs by Walking Wearing Elastic Stockings

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Carlos Alberto Carvalho ◽  
Renata Lopes Pinto ◽  
Maria de Fatima Guerreiro Godoy ◽  
Jose Maria Pereira de Godoy
Keyword(s):  
Signs And Symptoms ◽  
Chronic Venous Disease ◽  
Rank Test ◽  
Venous Disease ◽  
Water Displacement ◽  
Compression Stockings ◽  
Signed Rank ◽  
Reduction Of Pain ◽  
Signed Rank Test ◽  
Elastic Stockings

Aim. The objective of the current study was to evaluate the reduction of edema and pain with the use of elastic stockings.Method. The effect of walking on a treadmill for 50 minutes in the evening wearing elastic compression stockings on pain and edema was evaluated in a prospective randomized crossover clinical trial. In Assessment 1, the legs of participants were measured by volumetry at 7:00 a.m. and they were asked to perform their normal daily activities and to return at 4:00 p.m. Forty-two legs of 21 female patients with ages of the participants ranged from 32 to 72 years with signs and symptoms of chronic venous disease. The sizes of the legs of all patients were evaluated by water displacement volumetry and a visual analog scale was used to assess pain.Results. After walking for 50 minutes on the treadmill, the volume reduced (pairedt-test:pvalue < 0.03). In relation to pain, there was a reduction in pain after the treadmill session using the elastic stocking (Wilcoxon signed rank test:pvalue < 0.007).Conclusion. The reduction of edema and pain of the legs during the course of the day can be accomplished with the use of elastic stockings, as well as walking.

Comparison of Clinical and Photoplethysmographic Assessment of Venous Insufficiency

1993 ◽  
Vol 8 (3) ◽  
pp. 120-123 ◽  
Author(s):  
A. Kurgan ◽  
L. B. Lerenbuch ◽  
S. D. Gertz ◽  
J. Shapiro ◽  
B. Ofek ◽  
...  
Keyword(s):  
Clinical Assessment ◽  
Venous Insufficiency ◽  
Clinical Evidence ◽  
Venous System ◽  
Venous Reflux ◽  
Clinical Criteria ◽  
Deep Venous System ◽  
Methods Of Evaluation ◽  
Venous Surgery

Objective: To assess the concordance between clinical and photoplethysmographic evaluation of venous insufficiency. Design: Comparison of two methods of evaluation of venous insufficiency in randomly selected patients. Setting: The Vascular Institute, Shaare Zedek Hospital, Jerusalem, Israel. Patients: Four hundred patients selected at random from a pool of 3000 patients referred to the vascular institute for suspected venous insufficiency. Interventions: Each of the 800 legs was evaluated clinically, by Trendelenburg testing, and by venous reflux photoplethysmography (VPPG). Results: Of 230 legs without clinical evidence of venous insufficiency (including Trendelenburg testing), 214 (93%) were also normal by VPPG. However, of 359 legs with clinical evidence of venous insufficiency, only 178 (50%) were so confirmed by VPPG. Of 135 legs considered to have insufficiency of the deep venous system (DVI) by clinical criteria alone, only 31 (23%) were confirmed to have DVI by VPPG, and 49 (36%) were found by VPPG to have insufficiency of only the superficial system. Conclusions: Reliance upon clinical assessment alone is inadequate for distinguishing between insufficiency of the deep and superficial or perforating venous systems. Assessment by VPPG may identify many patients with dermatologic changes “typical of DVI” who may benefit from superficial venous surgery.

A near-infrared spectroscopy-assisted test discriminates patients with peripheral arterial disease and venous insufficiency with changes of foot oxygenation following light elastic compression therapy

VASA ◽  
2019 ◽  
Vol 48 (4) ◽  
pp. 361-367 ◽  
Author(s):  
Nicola Lamberti ◽  
Fabio Manfredini ◽  
Mirko Tessari ◽  
Erica Menegatti ◽  
Francesca Nardi ◽  
...  
Keyword(s):  
Infrared Spectroscopy ◽  
Near Infrared Spectroscopy ◽  
Venous Insufficiency ◽  
Near Infrared ◽  
Ankle Brachial Index ◽  
Area Under The Curve ◽  
Compression Therapy ◽  
Compression Stockings ◽  
Arterial Perfusion ◽  
Elastic Compression

Summary. Background: Elastic compression therapy (CT) in patients with peripheral artery disease (PAD) and chronic venous insufficiency (CVI) may compromise arterial perfusion. We evaluated the feasibility of a toe-flexion test, which quantifies dynamic foot perfusion by near-infrared spectroscopy (NIRS), for the assessment of hemodynamic sustainability of CT in PAD patients with CVI. Patients and methods: In this prospective observational study, PAD patients aged 50–85 with combined CVI at CEAP stages II–IV were studied. The ankle-brachial index (ABI) was measured, and foot perfusion was determined after 10 consecutive toe-flexion movements with NIRS sensors placed on the dorsum of each foot. Knee-high open-toe compression stockings were applied, and the degree of compression was measured. Toflex-area was determined by calculating the area under the curve of the oxygenated hemoglobin track recorded by NIRS. A toflex-area reduction > 20 % following CT was arbitrarily defined to identify limbs of patients with improved foot perfusion. These subjects received CT to be worn and a diary to report adherence and symptoms. Results: Forty-seven PAD patients (74 ± 9 years; ABI 0.67 ± 0.24) with CVI were enrolled. For all legs, superimposable toflex-areas were observed for the first two attempts (ICC 0.92). Following application of CT (17 ± 2 mmHg), the toflex-area improved (from –162 ± 110 a.u. to –112 ± 104 a.u.; p < .001). Sixty-two limbs (n = 32 patients) exhibited improved foot perfusion after CT, with a mean variation of 80 ± 47 a.u., while 32 limbs (n = 23 patients) showed stable or worsened values. In a regression model, favorable variations in toflex-area after CT were linked to a worse baseline toflex-area (R2 = 0.18; p < 0.001; rpartial = –0.42) while the percentage improvement directly correlated with CEAP class (p = 0.033). Conclusions: The NIRS-assisted test, which is feasible in a laboratory context, objectively discriminates the hemodynamic tolerability of the treatment and identifies subjects with combined PAD and CVI with improved perfusion after CT, in spite of the presence of PAD.

scholarly journals Therapeutic approach in patients with chronic venous insufficiency

2017 ◽  
Vol 12 (2) ◽  
pp. 28-32
Author(s):  
Marilena SPIRIDON ◽  
◽  
Dana CORDUNEANU ◽  
Keyword(s):  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Thrombus Formation ◽  
Venous Pressure ◽  
External Pressure ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Compression Stockings ◽  
Venous Valve ◽  
Severe Stage

Chronic venous insufficiency (CVI), frequent cause of lower limb edema, represents a severe consequence of the dysfunction of the venous valve, which results from the venous hypertension together with the degenerative processes at this level. CVI defines only the severe stages of the chronic venous disease (CVD), accompanied by morphological and functional damage, with significant alteration in quality of life. The treatment of CVI involves, depending on the severity of the case, a combination of general nonpharmacologic, pharmacologic, and surgical measures. Non-pharmacologic measures involve the use of a continuous and controlled external pressure represented by compression stockings which can significantly improve the venous return and lead to a major symptoms improvement. Pharmacologic treatment aims on one hand to alleviate hemodinamics by lowering blood viscosity, decreasing venous pressure and preventing intravascular thrombus formation and, on the other hand, restoring thevascular glycocalyx/endothelium, reducing parietal inflammation and increasing the venous wall tone. Within this pathology, sulodexide represents an innovative biological product with polypharmacological actions targeting more sites involved in the pathogenesis of CVD/CVI that alleviate hemodynamics and restore vascular structure which lead to a significant symptoms improvement and a slow disease progression. Surgery remains the procedure of choice in patients initially treated conservatively in whom symptoms persist or worsen, but also in case of those who already come to doctor in a severe stage of the disease.

The post-thrombotic syndrome and compression therapy

2014 ◽  
Vol 29 (1_suppl) ◽  
pp. 83-89 ◽  
Author(s):  
SK van der Velden ◽  
HAM Neumann
Keyword(s):  
Compression Therapy ◽  
Class Ii ◽  
Stiffness Index ◽  
Class Iii ◽  
Compression Stockings ◽  
Elastic Compression ◽  
High Stiffness ◽  
Post Thrombotic Syndrome

Compression therapy is still the cornerstone in the treatment of PTS. The therapy is primarily focused on the decrease of the AVP, enhancement of the microcirculation and reduction of the edema. In our practice, most patients are initially treated with short stretch bandage to reduce the edema. Medical Elastic Compression Stockings (MECS) class II (CEN 23–32 mm Hg)or class III (CEN 34–46 mm Hg) with a high stiffness index are prescribed after the edema is disappeared. The prescription will be for a lifelong usage of stockings. Correction of saphenous reflux, deobstructing and stenting might be considered in certain patients with PTS.

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