Indications for Medical Compression Stocking in Chronic Venous Diseases
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. Rabe discussed the usage of compression stockings in such states as symptoms of chronic venous diseases (CVD), quality of life, and edema. He was stating that symptoms are the key and important for the patients to use compression therapy.
Studies reported that compression provides relief of pain and leg cramps, in addition to improving quality of life and healing. Not only that, but also evidence demonstrated that low-ankle pressure GCTs help to prevent flight-induced ankle edema.
So, he recommended using compression stockings to prevent leg swelling, alleviate venous symptoms in CVD and improve individual’s health.
Moreover, some other studies comparing low compression (10-20 mmHG) to placebo (<or=6 mmHG) or no compression state that low compressions are favored to be used in decreasing subjective symptoms. It is able to reduce evening edema as well.
Skin changes could appear on different people for various reasons, compression stockings can be used to improve skin changes like eczema and inflammation in legs. Another study showed that MCS can improve skin changes in patients with lipodermatosclerosis.
Venous leg Ulcers (VLU) are open, often painful, sores in the skin that take more than a month to heal. They usually develop on the inside of the leg, just above the ankle.
Evidence shows that using high compression MCS lowers the rates of venous ulcer recurrence. Further, using “ulcer kits” improves VLU healing and reduces pain in patients with VLU.
To illustrate more, a study shows that two-layer ulcer MCS (ulcer kits) and Four-layer bandage treatment have similar ulcer healing rate as 70.9% hosiery 70.4% bandage respectively.
MCS may be more cost-effective compared to compression bandage (CB).
Some reasons why MCS may not be chosen:
- Circumferential ulcers / huge ulcer size
- Untypical locations (e.g., Foot)
- High amount of exudate
- Gross Edema
Further studies are needed to provide data on usage of MCS for prevention of CVD progression.
Evidence shows that usage of MCS in initial phase after great saphenous vein (GSV) treatment reduces postoperative side effects, also using eccentric compression to enhance effectiveness of MCS in reducing postoperative side effects. Furthermore, after GSV interventions patients with chronic venous insufficiency (CVI) symptoms use prolonged MCS to improve clinical success and the use of MCS after liquid sclerotherapy of C1 veins to achieve better outcomes.
Post-thrombotic syndrome (PTS) is a condition that can happen to people who have had deep vein thrombosis (DVT) of the leg. It can cause chronic pain, swelling, and other symptoms in the leg.
Immediate application of MCS after diagnosis of DVT in order to prevent PTS and also for treatment of symptomatic PTS.
A study then compares the use of immediate compression and no immediate compression after 3 months. It showed that the immediate compression has significantly less objective Villalta parameters with less skin induration, hyperpigmentation, venectasia and less pain of calf compression.
Based on current evidence, 14 recommendations for chronic venous disorders and 2 for prevention of PTS were made.