Perspectives on Chronic Venous Insufficiency

Compression therapy is the use of compression socks, stockings, boots, or bandages to apply gentle pressure to the legs. Doctors prescribed compression therapy for thousands of years. Modern science continues to discover new benefits of compression therapy. Dr. Christopher started by introducing compression classification and its importance as he discussed tension devices, and not pure pressure devices because we believe the tension is the root of most of the complications and the law of Laplace; they can be divided into two elastic compression devices, which have sustained pressure and a rise in tissue pressure, and inelastic compression, which have rapid elevations in tissue pressure.

Dr. Eberhard Rabe started his presentation with studies showing improvement in using medical compression stockings. He said that 51 new pieces of evidence recommend using these stockings for various diseases. In this presentation, the objectives are to provide update of the recommendations in the 2008 consensus statement, fill gaps identified in the earlier consensus statement and provide graded recommendations for the clinical goal of treatment using medical compression stockings (MCS).

Dr. Tomasz Urbanek starts the speech by the general recommendation: "We recommend that every patient receiving compression therapy should be screened for conditions that increase the risk of complications and every compression device should be checked for appropriate fit and application."

Dr Tobias Hirsch presented topics about oedema drainage and cardiac insufficiency as well borderline indications.

Elastic compression stockings for prevention of the post-thrombotic syndrome in patients with and without residual vein thrombosis and/or popliteal valve reflux // The comparative efficacy of conventional short-stretch multilayer bandages and velcro adjustable compression wraps in active treatment phase of patients with lower limb lymphedema // Editor’s choice – European Society for Vascular Surgery (ESVS) 2022 clinical practice guidelines on the management of chronic venous disease of the lower limbs

Compression therapy is not contraindicated in diabetic patients with venous or mixed leg ulcer // Is compression therapy contraindicated in lower leg erysipelas? Results of a retrospective analysis. // Occupational leg edema - use of compression stockings

Risks and Contraindications of Medical Compression Treatment – A Critical Reappraisal. An International Consensus Statement.

Better wearing comfort of knee-length elastic compression stockings with an interface pressure of 18–21 mmHg compared to 23–32 mmHg in elderly people after a one day trial – Influence on foot deformities, rheumatism and arthritis. // High tolerance of progressive elastic compression in peripheral arterial disease. // Effect of lower leg compression during caesarean section on post-spinal hypotension and neonatal hemodynamic parameters: nonrandomized controlled clinical trial.

Validation of a gravitational model to study local endogenous biomarkers in chronic venous insufficiency // Graduated compression stockings for prevention of deep vein thrombosis Comparison of 15–20 mmHg versus 20–30 mmHg compression stockings in reducing occupational oedema in standing and seated healthy individuals // Treatment protocol on stasis edema in poorly mobile nursing home patients

Control of lower extremity edema in patients with diabetes: double blind randomized controlled trial assessing the efficacy of mild compression diabetic socks // Effects of compression stockings on elevation of leg lymph pumping pressure and improvement of quality of life in healthy female volunteers: A randomized controlled trial // Compression use in the era of endovenous interventions and wound care centres //Acceptance, compliance and effects of compression stockings on venous functional symptoms and quality of life of Italian pregnant women

Eliciting patients’ preferences for elastic compression stocking therapy after deep vein thrombosis: potential for improving compliance // Compression therapy – current practice of care: level of knowledge in patients with venous leg ulcers // Impact of compression stockings vs continuous positive airway pressure on overnight fluid shift and obstructive sleep apnea among patients on dialysis // A randomized crossover trial on the effect of compression stockings on nausea and vomiting in early pregnancy

Hemodynamic performance of low strength below knee graduated elastic compression stockings in health, venous disease, and lymphedema // Venous leg symptoms in healthy subjects assessed during prolonged standing // The effects of short-term use of compression stockings on health related quality of life in patients with chronic venous insufficiency // A compression kit of a stocking and three superimposed leggings is easy to don and dose adjustable

Booster study: Comparative evaluation of a new concept of elastic stockings in mild venous insufficiency //A randomized double-blind trial of upward progressive versus degressive compressive stockings in patients with moderate to severe chronic venous insufficiency // Compression stockings with a negative pressure gradient have a more pronounced effect on venous pumping function than graduated elastic compression stockings // Interface pressure and venous drainage of two compression stocking types in healthy volunteers and in patients with hemodynamic disturbances of the legs

Editor’s choice – Management of chronic venous disease: Clinical practice guidelines of the European Society for Vascular Surgery (ESVS) // Compression therapy: Scientific background and practical applications // A study of leg edema in immobile patients

Prof. Joseph Caprini, Emeritus at the NorthShore University Health System in Evanston, Illinois and a senior clinician-educator at the University of Chicago Pritzker School of Medicine, believes that individual risk assessment of thrombosis in Covid-19 patients is a fundamental part of analyzing the pandemic! As the number and power of risk factors increase in the Caprini Score, the incidence of thrombosis increases, resulting in a score that has been validated in 5 million patients. There is a non-linear increase in clinical venous thromboembolism incidence as the score increases! But capturing the 40 elements in the Caprini Score is a time-consuming process! However, it can be facilitated by having the patient complete a preliminary form in advance of elective surgery with the help of family members. That is why physicians should review the initial documents filled by the patients and their families. However, is there really a connection between Thrombosis and Covid-19?

Prof. Jinsong Wang started the taking with the Covid 19 started in December 2019 broke out worldwide and how the frontline medical staff is at high risk for occupational exposure and infection also preventing nosocomial infections is a particularly important and challenging task during the pandemic.

Venous thromboembolism (VTE) prophylaxis consists of pharmacologic and nonpharmacologic measures to diminish the risk of deep vein thrombosis (DVT) and pulmonary embolism (PE). Dr. Kirill Lobastov started his talk by the incidence of venous thromboembolism in patients with covid infection. It was found in 11 studies with more than 1500 thousand participants. In most of these studies, patients used low molecular heparins in prophylactic intermediate therapeutic toes. It was about 13 percent, and pulmonary embolism was about eight. In the intensive care unit, it was high that pulmonary embolism occurred in about 18 percent of all patients.

Elastic compression stockings for prevention of the post-thrombotic syndrome in patients with and without residual vein thrombosis and/or popliteal valve reflux // The comparative efficacy of conventional short-stretch multilayer bandages and velcro adjustable compression wraps in active treatment phase of patients with lower limb lymphedema // Editor’s choice – European Society for Vascular Surgery (ESVS) 2022 clinical practice guidelines on the management of chronic venous disease of the lower limbs

Validation of a gravitational model to study local endogenous biomarkers in chronic venous insufficiency // Graduated compression stockings for prevention of deep vein thrombosis Comparison of 15–20 mmHg versus 20–30 mmHg compression stockings in reducing occupational oedema in standing and seated healthy individuals // Treatment protocol on stasis edema in poorly mobile nursing home patients

One versus two years of elastic compression stockings for prevention of post-thrombotic syndrome (OCTAVIA study): randomised controlled trial // Individualised versus standard duration of elastic compression therapy for prevention of post-thrombotic syndrome (IDEAL DVT): a multicentre, randomised, single-blind, allocation-concealed, non-inferiority trial // Clinical and economic impact of compression in the acute phase of deep vein thrombosis Compression therapy for prevention of post-thrombotic syndrome.

Eliciting patients’ preferences for elastic compression stocking therapy after deep vein thrombosis: potential for improving compliance // Compression therapy – current practice of care: level of knowledge in patients with venous leg ulcers // Impact of compression stockings vs continuous positive airway pressure on overnight fluid shift and obstructive sleep apnea among patients on dialysis // A randomized crossover trial on the effect of compression stockings on nausea and vomiting in early pregnancy

Lower limbs venous compression reduces the incidence of maternal hypotension following epidural analgesia during term labor // Compression stockings for the prevention of venous leg ulcer recurrence: a health technology assessment // Compression therapy to prevent recurrent cellulitis of the leg

Better wearing comfort of knee-length elastic compression stockings with an interface pressure of 18–21 mmHg compared to 23–32 mmHg in elderly people after a one day trial – Influence on foot deformities, rheumatism and arthritis. // High tolerance of progressive elastic compression in peripheral arterial disease. // Effect of lower leg compression during caesarean section on post-spinal hypotension and neonatal hemodynamic parameters: nonrandomized controlled clinical trial.

Control of lower extremity edema in patients with diabetes: double blind randomized controlled trial assessing the efficacy of mild compression diabetic socks // Effects of compression stockings on elevation of leg lymph pumping pressure and improvement of quality of life in healthy female volunteers: A randomized controlled trial // Compression use in the era of endovenous interventions and wound care centres //Acceptance, compliance and effects of compression stockings on venous functional symptoms and quality of life of Italian pregnant women

Eliciting patients’ preferences for elastic compression stocking therapy after deep vein thrombosis: potential for improving compliance // Compression therapy – current practice of care: level of knowledge in patients with venous leg ulcers // Impact of compression stockings vs continuous positive airway pressure on overnight fluid shift and obstructive sleep apnea among patients on dialysis // A randomized crossover trial on the effect of compression stockings on nausea and vomiting in early pregnancy

Lower limbs venous compression reduces the incidence of maternal hypotension following epidural analgesia during term labor // Compression stockings for the prevention of venous leg ulcer recurrence: a health technology assessment // Compression therapy to prevent recurrent cellulitis of the leg

Adjustable compression wrap devices are cheaper and more effective than inelastic bandages for venous leg ulcer healing. A Multicentric Italian Randomized Clinical Experience // Importance of adequate pressure in compression therapy. Basis for successful treatment // Round-knit or flat-knit compression garments for maintenance therapy of lymphedema of the leg? – Review of the literature and technical data

Eliciting patients’ preferences for elastic compression stocking therapy after deep vein thrombosis: potential for improving compliance // Compression therapy – current practice of care: level of knowledge in patients with venous leg ulcers // Impact of compression stockings vs continuous positive airway pressure on overnight fluid shift and obstructive sleep apnea among patients on dialysis // A randomized crossover trial on the effect of compression stockings on nausea and vomiting in early pregnancy