Compression garments for varicose veins normalize blood flow, partially compensate for valvular insufficiency, and relieve pain and fatigue. It is used both before varicose vein treatment and after to facilitate recovery. They are effective in conservative and minimally invasive treatments, eliminating the need for dressings and allowing you to obtain a real result that corresponds to the expected one.
In 2018, a large study was conducted on the effect of compression stockings in the conservative treatment of varicose veins. It turned out that when using the first class of compression, the course of the disease slows down significantly, pain and swelling disappear. The positive effect of compression after surgical and minimally invasive treatment has been demonstrated many times; Large studies have been conducted since 1985.
Currently, three types of compression underwear are produced: tights, stockings of various heights and knee-high socks. The compression class is prescribed by a phlebologist during an in-person consultation.
Elastic compression of the lower extremities is not new in medicine. In Ancient Egypt, slaves and workers practiced foot binding to increase stamina and performance, and legionnaires in the Roman Empire bound their feet during long walks. A similar method was later used in the 17th and 19th centuries by factory and plantation workers to speed up the recovery process and reduce swelling in the extremities after a hard day.
The method of dosed external compression was also used in medicine. The feasibility of its use in venous pathology was identified in the time of Hippocrates. Already then, a disease was described with the presence of bulging superficial vessels in the leg, swelling of the affected limb and a tendency to form ulcers. And pressure bandages and spiral bandages were widely used for its treatment.
This technique was not forgotten. Gradually, new methods of bandaging the limbs in case of varicose veins and chronic venous insufficiency were developed. Elastic compression was also used as an independent method. The most used materials were cotton and knitted fabric and rubber strips.
The breakthrough was the appearance of an elastic bandage. It was patented in 1845 by the British businessman and inventor Stephen Perry and was later improved. Later, bandages of 3 degrees of elongation began to be produced based on various materials. They are still in use today. But the elastic bandage has a number of important disadvantages.
Disadvantages of an elastic bandage:
- inconvenience;
- dependence of the result on careful compliance with the application technique;
- the probability of uneven compression distribution;
- unsightly;
- risk of displacement of turns of material.
In 1848 another product was patented, which fueled the emergence of a new direction in compression therapy. William Brown invented stockings that allowed distributed circular pressure to be applied to the lower extremities. Over time, advances in light industry made the production of tights possible. And currently, it is compression stockings that are recommended for various diseases that affect the veins of the lower extremities.
Classification of compression stockings.
Modern compression products are available in the form of tights, stockings of various heights and knee-high socks. But they are not only divided by appearance. They are also divided into classes based on the degree of compression they provide. It is measured in millimeters of mercury.
The classification of the compression products used is based on the German standard adopted in Europe RAL-GZ 387. It is the most strict and regulates the nature of the pressure distribution and its compliance with the physiological patterns of venous flow, the quality and composition of the materials. used.
Compression garments are divided into 4 classes:
- Easy.Compression 18 to 21 mm Hg.
- Average (moderate).Compression 23 to 32 mm Hg.
- Strong.Compression 34 to 46 mm Hg.
- Very strong.Compression 49 mm Hg.
The term "tightness" is sometimes used to describe compression stockings and pantyhose. In fact, it is an incorrect substitute for the concept of "compression". This pseudo-medical formulation is based on the fact that with an increase in the level of pressure applied, underwear becomes less elastic and denser to the touch. But using this term, and even more so trying to find a correspondence between the compression class and the density of normal meshes (measured in DEN), is illiterate and fundamentally incorrect.
What is the difference between compression underwear and regular tight stockings?
Compression stockings do more than simply compress the soft tissue in your legs. The pressure it exerts is carefully calculated and strictly dosed, which is ensured by the use of special materials with a special weave and thread composition. According to the RAL-GZ 387 standard, pantyhose and stockings cannot be transparent, translucent, colored or printed.
An important feature of compression stockings is the pressure gradient - its gradual decrease as it increases from the level of the ankle joint to the thigh. Furthermore, these changes correspond to the physiological characteristics of peripheral veins and the nature of blood flow.
The greatest pressure is found in the supramalleolar region. Compression begins in the upper third of the foot, involving the ankle joint; It is here where the great saphenous vein originates on the medial side and its main tributaries are located. Approximately at the level of the transition from the belly of the calf muscle to the Achilles tendon, the pressure exerted by the stockings already represents approximately 65-70% of the supramalleolar pressure. At the knee it is approximately 50%. And in the lower third of the thigh: 40% of the original.
The gradient acts in a dosed manner on the peripheral superficial veins of the lower extremities and creates a blood flow close to physiological.
What changes when using compression garments for varicose veins?
Compression stockings exert a measured circular pressure, the level of which is determined by the compression class. The most affected are bulging varicose veins, which occur according to Laplace's law. All other superficial vessels are also pressed.
On a mechanical level:
- Reducing the diameter of the venous vessels allows you to reduce the volume of deposited and stagnant blood.
- Pressing on the varicose veins helps reduce the effect of valvular insufficiency and reduce the return flow of blood.
- Reduce the volume of horizontal reflux through the perforating vessels, increasing blood discharge into the deep veins of the leg.
- Improved functioning of the calf muscle pump.
In general, compression stockings and stockings have a symptomatic effect and reduce the severity of chronic venous insufficiency. Lingerie creates comfort for severe varicose veins. However, we cannot talk about a cure: the patient only improves the quality of life and reduces the likelihood of complications.
Compression garments do not eliminate varicose veins, do not restore the structure of the walls of peripheral vessels and cannot replace surgery. It only allows you to correct existing signs of venous insufficiency, and this effect lasts only while wearing tights/stockings.
The result of wearing compression knit underwear:
- reduced swelling of the lower leg and ankle, even at night and after prolonged standing;
- reduction in the severity of pain, which is explained by a decrease in the degree of stagnation of venous blood and an improvement in tissue trophism;
- reduce the risk of thrombosis;
- reduce the severity of trophic disorders and reduce the likelihood of their occurrence;
- reduce the duration of the rehabilitation period after surgical interventions and minimally invasive manipulations on veins;
- reduce the feeling of discomfort in the legs;
- reduce the frequency and severity of leg muscle cramps.
The use of compression garments is recommended for varicose veins of any stage, postphlebothrombotic syndrome (PFTS). In some cases, it is also recommended for reticular varicose veins and telangiectasias (spider veins), lymphostasis of the lower extremities.
Particular importance is attached to compression therapy after operations and minimally invasive endovascular procedures (EVLO, laser obliteration, RFO). The use of specialized knitwear significantly increases the effectiveness of this type of intervention.
Indications and contraindications.
Indications:
- After sclerotherapy for better contact and subsequent fibrous "gluing" of the walls of the sclerosed vessel.
- Pronounced tissue changes due to chronic venous insufficiency (in the presence of trophic ulcers, lipodermatosclerosis).
- Phlebitis of the superficial veins.
- Swelling, pain, fatigue in the legs.
- Tendency to be overweight.
Contraindications:
- clinically significant obliterative atherosclerosis of the lower extremities;
- endarteritis;
- pustular skin diseases of the lower extremities and microbial eczema;
- pressure ulcers;
- open wounds;
- diabetes mellitus with signs of endocrine polyneuropathy and impaired microcirculation in the distal extremities;
- acute cardiovascular failure.
Your doctor determines the possibility of wearing compression stockings. A change in the patient's condition and the appearance of new symptoms require a second consultation with a phlebologist to determine other treatment tactics.
How to choose a compression product?
Compression garments cannot be chosen independently, they are prescribed exclusively by a phlebologist based on an examination and ultrasound of the veins of the lower extremities.
Make the right choice
When choosing compression, take the following into account:
- the nature and speed of venous blood flow;
- severity of vertical and horizontal pathological reflux;
- the presence of an obstruction in the outflow of blood, which is most often caused by thrombosis.
Many patients have a completely logical question: why go to the doctor if the package of underwear contains a description of compression classes and their indications? Is it not possible to get by with the help of a consultant in an orthopedic salon?
No, self-analysis of symptoms is not enough to correctly select compression garments: the doctor does not only focus on the degree of venous insufficiency and clinical symptoms. Other factors are also important. And the determining parameters are often age and the presence of concomitant somatic pathology: sometimes the use of a high class of compression leads to a deterioration in the general condition, despite the correction of venous insufficiency.
Observe the compression level and the mode of use.
Risks of using class 3 compression in old age:
- Risk of stroke, heart attack.
- Severe cardiovascular failure.
Determining treatment tactics and selecting the class and type of compression stockings is the prerogative of the doctor. But the consultant of an orthopedic salon can take care of the selection of the size and height of the product. He will also give you detailed care instructions and teach you how to properly put on compression stockings and pantyhose.
Preference should be given to brands whose manufacturers are guided by the RAL-GZ 387 standard. This will be indicated by the corresponding icon on the packaging. The standard is a guarantee of high quality, physiology and predictability.
High-quality therapeutic anti-varicose jersey is not sold in pharmacies. The products are presented in orthopedic salons.
Do not save money, do not buy fakes or products from unknown manufacturers. The compression will almost certainly differ from the declared one and the durability of the product will be low.
How to use and how much to use.
The stocking is first turned and folded into a roll, and then stretched along the leg from bottom to top. This will ensure proper pressure distribution and prevent product deformation. There are also special devices that facilitate its placement. They can also be purchased at orthopedic stores.
It is advisable to wear compression stockings in the morning while still in bed: this is when the swelling in the legs is usually minimal, so that optimal compression of the veins can be achieved. It is also recommended that before putting on the tights you keep your legs elevated for a few minutes and "work" your feet to further increase the outflow of venous blood and lymph.
Anti-varicose compression products are sometimes worn for a long time and removed only at night before bedtime. These recommendations can be given, for example, for postphlebothrombotic syndrome (PFTS), thrombophlebitis, and persistent edematous syndrome. In other cases (with initial varicose veins), it is enough to wear such stockings (stockings) only during periods of static or dynamic loads. The rules for wearing compression garments are determined by your doctor.