![]() Some studies reported that low-compression stockings were as effective as high-compression stockings but had a better compliance rate. 1 Recently, the National Institute for Health and Care Excellence (NICE) in the United Kingdom recommended against the use of graduated compression stockings to treat varicosities unless interventional treatment is unsuitable. The review also found no evidence that wearing the stockings slowed the progression or prevented the recurrence of varicose veins.Ĭonsensus statements from the Society for Vascular Surgery/American Venous Forum Guideline Committee cautiously recommended the use of graduated compression stockings in this group of patients and accepted that the evidence supporting this recommendation was limited. ![]() 6 Wearing the stockings improved symptom management, but the findings may have been confounded by the exclusion of a high number of noncompliant patients within the trials. Another systematic review of graduated compression stockings for uncomplicated varicosities identified 25 studies. ![]() 11 Although the participants’ symptoms and physiologic measures subjectively improved in all of the studies when graduated compression stockings were worn, there was a risk of bias because the assessments were not made by comparing one randomized arm with a control arm. The evidence for the benefit of graduated compression stockings in uncomplicated varicose veins was equivocal, and the published literature was often contradictory and had methodologic flaws.Ī Cochrane systematic review of graduated compression stockings for the initial treatment of varicosities in patients without venous ulceration (CEAP class C 2–C 4) included seven RCTs ( n = 356). 8 Textile properties, including fabric roughness, thermoregulation and dye, may contribute to skin reactions. For example, in CLOTS (Clots in Legs or Stockings after Stroke) trial 1 - a multicentre randomized controlled trial (RCT) that assessed the effectiveness of thigh-length graduated compression stockings to reduce the risk of deep vein thrombosis after stroke in about 2500 patients - skin breaks, ulcers, blisters and necrosis were significantly more common among patients wearing the stockings than among those not wearing them (5.1% v. 6, 7 Patients who are allergic to the stocking material may develop contact dermatitis, skin discoloration and blistering. The use of graduated compression stockings on legs with impaired arterial flow can worsen ischemia. Poorly fitting stockings can cause discomfort and, at worst, pressure necrosis. ![]() 6 – 9 The stockings are generally safe to use, with relatively few complications. The contraindications of graduated compression stockings are listed in Box 3. 4 Another study showed that levels of proinflammatory cytokines (e.g., interleukin-1α, interleukin-6 and interferon-γ) in ulcer tissue in patients with active ulcers were significantly reduced following compression therapy. 2, 4, 5 One study that used near-infrared spectroscopy to monitor changes in tissue oxyhemoglobin and deoxyhemoglobin reported that limb oxygenation increased with the use of graduated compression stockings, especially with high-compression stockings. ![]() 3 It also initiates complex physiologic and biochemical effects involving the venous, arterial and lymphatic systems, although the exact mechanisms remain unclear. 2 Graduation compression can reverse venous hypertension, augment skeletal-muscle pump, facilitate venous return and improve lymphatic drainage. The application of adequate graduated compression reduces the diameter of major veins, which increases the velocity and volume of blood flow. The pressure gradient ensures that blood flows upward toward the heart instead of refluxing downward to the foot or laterally into the superficial veins. The stockings work by exerting the greatest degree of compression at the ankle, with the level of compression gradually decreasing up the garment. What are the mechanisms of action of compression stockings?įigure 2 summarizes the mechanisms of action of graduated compression stockings. ![]()
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