The Structure and Compression of Medical Compression Stockings

This paper lays out standards of compression stockings and their classification into classes. The analysis of knitted fabric structure parameters, elongation and compression of moderate- and high-compression stockings was conducted. Stocking compression on specific parts of the stocking leg was measured on three sizes of a wooden leg model. For moderate-compression stockings, compression above the ankle was 32 hPa. For high-compression stockings, compression above the ankle was 60 hPa. Both groups of the analyzed compression stockings were made on modern one-cylinder hosiery automats. The legs of the stockings were made in single inlaid jersey 1 + 1. Both yarns were elastane covered. The finer yarn formed loops and its knitting into a course was significantly larger than in the other yarn, which was much coarser and does not form loops but “lay the weft in a bent way”. The smallest elongation of knitted fabric was above the ankle, where the highest compression was achieved, while the largest elongation was under the crotch, where the stocking leg exerted the smallest compression on the surface. The leg of the compression stocking acted as a casing that imposed compression on the leg and often reinforced it to be able to sustain compression loads.

Prevention of leg cramps by using compression stockings or magnesium supplements in the 50–84 age group: study protocol for a randomised controlled trial

Background Leg cramps are painful sensations of tightening in the muscles of the legs that commonly appear during the night and are often associated with secondary insomnia. They are common especially in older age. There is no evidence that any method of prevention of nocturnal leg cramps is both safe and effective. There are no previous trials concerning cramp prevention by using compression stockings. The objective of this study is to assess in a prospective randomised controlled trial whether leg cramps can be prevented by the daily use of knee-length compression stockings or magnesium supplements. Methods The study will be set in Finland, and 50–84-year-old volunteers will be recruited through Google Ads, the Finnish health library website and Finnish primary health care centres. The participants must have a minimum of two episodes of leg cramps per week for the past 4 weeks to be included in the study. The participants (n = 225) will be allocated to three equal groups: the compression stocking arm, the magnesium supplement arm and the placebo arm. The participants will go through 4 weeks of follow-up without intervention and then another 4 weeks of follow-up with the assigned intervention. The material for the study will be collected through electronic questionnaires. Discussion This protocol describes a study that compares compression stockings, magnesium supplements and placebo for the prevention of leg cramps. The results of this study can significantly improve knowledge on the methods of preventing leg cramps. Trial registration ClinicalTrials.gov NCT04694417. Registered on Jan 4, 2021.

Postoperative morbidity differences between proximal and distal knee saphenous harvesting in coronary artery bypass graft surgery

Objectives. Coronary artery bypass grafting (CABG) is the most common procedure in cardiac surgery and the great saphenous vein (GSV) are the preferred conduits. The effects of saphenous vein incision (SVI) harvesting site choice on SVI wound complications, pretibial edema, and the need for compression stockings were evaluated retrospectively in patients undergoing CABG surgery. Materials and Methods. A total of 1900 patients operated for CABG between 2003 and 2021 in our clinic were included in this study, with GSV harvest performed at below-knee level (Group-A, n:841) and above-knee level (Group-B, n:1059). SVI was made 2 cm superior and 1 cm anterior to the medial malleolus in group-A; and 3 cm superior to medial epicondyle, extending to 3 cm inferior to the inguinal ligament in group-B. Examination for edema was made with 4-5 seconds of thumb pressure at the ankle level, then the depth of the pit was measured. Results. Ankle edema (Group-A n:132, Group-B n:25), the use of compression stockings (Group-A n:97, Group-B n:13), and paresthesia (Group-A n:51, Group-B n:10) were different between the two groups and the differences were statistically significant. However, prolonged wound healing (Group-A n:11, Group-B n:38), superficial wound infection (Group-A n:6, Group-B n:11), hematoma (Group-A n:4, Group-B n:9), and lymphorrhea (Group-A n:4, Group-B n:7) incidences were not statistically different between the two groups. Conclusions. Among patients with GSV extracted using the open conventional surgery technique, pretibial edema, paresthesia, and compression stocking use were observed less frequently in patients with preoperative doppler-ultrasonography evaluation and above-knee saphenous harvest.

Using the Functional Resonance Analysis Method to explore how elastic compression therapy is organised and could be improved from a multistakeholder perspective

ObjectivesElastic compression stocking (ECS) therapy is an important treatment for patients with deep venous thrombosis (DVT) and chronic venous insufficiency (CVI). This study aimed to provide insight into the structure and variability of the ECS therapy process, its effects on outcomes, and to elicit improvement themes from a multiple stakeholder perspective.DesignThirty semi-structured interviews with professionals and patients were performed. The essential functions for the process of ECS therapy were extracted to create two work-as-done models using the Functional Resonance Analysis Method (FRAM). These findings were used to guide discussion between stakeholders to identify improvement themes.SettingTwo regions in the Netherlands, region Limburg and region North-Holland, including an academic hospital and a general hospital and their catchment region.ParticipantsThe interviewees were purposely recruited and included 25 healthcare professionals (ie, general practitioners, internists, dermatologists, nurses, doctor’s assistants, occupational therapists, home care nurses and medical stocking suppliers) and 5 patients with DVT or CVI.ResultsTwo FRAM models were created (one for each region). The variability of the functions and their effect on outcomes, as well as interdependencies between functions, were identified. These were presented in stakeholder meetings to identify the structure of the process and designated variable and uniform parts of the process and its outcomes. Ultimately, six improvement themes were identified: dissemination of knowledge of the entire process; optimising and standardising initial compression therapy; optimising timing to contact the medical stocking supplier (when oedema has disappeared); improving the implementation of assistive devices; harmonising follow-up duration for patients with CVI; personalising follow-up and treatment duration in patients with DVT.ConclusionsThis study provided a detailed understanding of how ECS therapy is delivered in daily practice by describing major functions and variability in performances and elicited six improvement themes from a multistakeholder perspective.

Does intraoperative mechanical prophylaxis prevent venous thromboembolism in total knee arthroplasty? – effectiveness of passive-assisted ankle motion in surgical/non-surgical side

Background Gradual compression stocking (GCS) and intermittent pneumatic compression device (IPCD) are used for intraoperative mechanical prophylaxis against venous thromboembolism (VTE) during total knee arthroplasty (TKA). In this study, we applied a passive-assisted ankle motion in combination with GCS and IPCD during TKA and evaluated its effectiveness in preventing postoperative VTE. Methods We included 77 patients who underwent primary unilateral TKA. Patients were divided into group A (53 patients who underwent GCS and IPCD on their non-surgical side limb) and group B (24 patients who underwent passive ankle dorsiflexion motion in addition to GCS and IPCD on their non-surgical side limb). Deep vein thrombosis (DVT) was assessed using lower extremity ultrasonography (US). The incidence of VTE in each affected limb was compared between the two groups. Results US was performed 4 days after surgery on average. The incidence of DVT in groups A and B was 47.2 and 70.8 %, respectively. In group A, 22.6 % of DVTs were found only on the surgical side, 11.3 % on the non-surgical side, and 13.2 % on both sides. On the other hand, in group B, 41.7 % of DVTs were found only on the surgical side, 4.2 % on the non-surgical side, and 25.0 % on both sides. No significant difference in the incidence of VTE was noted between the 2 groups. Conclusions The intraoperative application of passive ankle motion plus GCS and IPCD might not further reduce the incidence of postoperative DVT in TKA patients.

Effect of Compression Stockings after Endovenous Laser Ablation of the Great Saphenous Vein with a 1470 nm Diode Laser Device and a 2ring Fiber

The aim of this study was to demonstrate the effects of compression following the endovenous laser ablation (EVLA) of incompetent great saphenous veins (GSVs) using a 1470 nm diode laser (Ceralas E 1470 nm, biolitec) and a 2ring radial fiber (ELVeS Radial 2ring™, biolitec). In this single-center prospective study, 150 legs of 150 consecutive patients were randomly allocated to one of three groups (A, B, and C). Group A patients did not undergo postoperative compression. Group B patients wore a thigh-length graduated compression stocking (23–32 mmHg) for 7 days, whereas group C patients wore the same stocking for 28 days. No additional phlebectomies or sclerotherapies were performed. Investigations were performed prior to intervention, at the day of intervention (D0), at day 7 (D7), and at day 28 post intervention (D28). The primary endpoint was post-interventional pain measured on a 10-point scale. A significant but small pain decrease was observed in the first week of compression, by comparing group B’s mean pain scores to those of group A (p = 0.009). Wearing a compression stocking after EVLA reduced pain within the first week on a significant, but low level. Taking the very low differences in pain levels into account, the difference may not be clinically relevant and post-treatment compression may not be necessary if no additional phlebectomies or sclerotherapies are performed.

A systematic review and meta-analysis comparing the efficacy of cyanoacrylate ablation over endovenous thermal ablation for treating incompetent saphenous veins

Objectives The aim of this study was to systemically review and analyze the efficacy of cyanoacrylate ablation (CA) in comparison with endovenous thermal ablation (ETA) for the treatment of incompetent saphenous veins. Methods A systematic literature search was conducted using databases of Pubmed, Embase, and Cochrane Library from the times of their inception to April 2020. Studies were selected based on inclusion and exclusion criteria after assessing the risk of bias in comparative studies with Cochrane and rating quality of evidence with the GRADE methodology. The meta-analysis was carried out using the Review Manager 5.4 program to conduct homogeneity tests. Results One cohort study and three randomized controlled trials (RCT), including a total of 1457 participants were included in the meta-analysis. ETA included endovenous laser ablation (ELVA) and radiofrequency ablation (RFA) in the selected studies. Comparison between CA and a combination of EVLA and RFA or RFA alone were carried out in two of RCTs, while comparison between CA with EVLA was conducted in one RCT and the cohort study. There was no statistical difference in closure rates between CA and ETA after pooled analysis. Similar symptom alleviation observed between different groups. However, the CA group showed a lower ecchymosis rate than RFA and a significantly lower incidence of adverse events, such as ecchymosis, phlebitis and paresthesia, than EVLA. Compared with ETA, the patients received CA treatment exhibited lower pain scores in a shorter procedure duration without needing compression stocking, returned to normal life sooner, and had significantly better quality of care. There was no significant difference in the number needed to treat for additional therapy after three months of follow-up between groups. Conclusions This meta-analysis indicates that CA has better overall outcomes than ETA and offers superior clinical benefits in the treatment of incompetent saphenous veins.