Compression stockings

Compression garment

Compression stockings (Flight Socks, Support Bandage) are a specialized hosiery designed to help prevent the occurrence of, and guard against further progression of, venous disorders such as edema, phlebitis and thrombosis. Compression stockings are elastic compression garments worn around the leg, compressing the limb. This reduces the diameter of distended veins and increases venous blood flow velocity and valve effectiveness. Compression therapy helps decrease venous pressure, prevents venous stasis and impairments of venous walls, and relieves heavy and aching legs. Knee high compression stockings are used not only to help increase circulation, but also to help prevent the formation of blood clots in the lower legs. They also aid in the treatment of ulcers of the lower legs. Unlike traditional dress or athletic stockings and socks, compression stockings use stronger elastics to create significant pressure on the legs, ankles and feet. Compression stockings are tightest at the ankles and gradually become less constrictive toward the knees and thighs. By compressing the surface veins, arteries and muscles, they force circulating blood through narrower channels. As a result, the arterial pressure is increased, which causes more blood to return to the heart and less blood to pool in the feet. There are two types of compression stockings, gradient and anti embolism.

Treatment is usually prescribed by a physician to relieve all manifestations of chronic venous disease and prevent venous troubles. The use of elastic compression stockings can reduce volumetric variations during standing hours. Compression stockings are recommended under the following conditions:

Edema is a condition where the opposing forces that occur in the small blood vessels and capillaries cause a net ultrafiltration of plasma water into the soft tissues.

Chronic peripheral venous insufficiency is when the veins cannot pump deoxygenated blood back to the heart.

Varicose veins are saccular and distended veins which can expand considerably and may cause painful venous inflammation. Once developed, they will not disappear on their own. The formation of varicose veins is an externally visible sign of venous weakness. Many physicians and vein specialists recommend wearing compression stockings after varicose vein stripping, but studies show that wearing an elastic compression stocking has no additional benefit after the application of elastic bandaging for three days in post operative care following the stripping of the great saphenous vein as assessed by control of limb, edema, pain, complications and return to work.

Deep vein thrombosis occurs when blood flow decreases (especially in the lower extremities), causing blood to pool in the legs and leading to blood clot (thrombus) formation. Evidence does not suggest a benefit in post thrombotic syndrome rates following DVT. Compression stockings are beneficial in reducing symptomless deep vein thrombosis among airline passengers flying for 7 hours or more. Pharmacological (warfarin, unfractionated heparin, low molecular weight heparin) and mechanical measures (graded compression stockings, intermittent pneumatic compression devices, and venous foot pumps) are used to prevent venous thromboembolism (VTE) in clinical practice. For cases in which the bleeding risk is high and pharmacologic measures are contraindicated, the use of mechanical prophylaxis is recommended. Twenty randomized controlled trials analyzed the effectiveness of graduated compression stockings alone or with other additional prophylaxis in prevention of deep vein thrombosis. These trials included 1,681 patients after general surgery, orthopedic surgery, and medical patients. They concluded that graduated compression stockings are effective in deep vein thrombosis prophylaxis in patients who have undergone general and orthopedic surgery. Combining graduated compression stockings with other mechanical and pharmacological measures can increase the effectiveness of VTE prophylaxis by 60%.

Lymphedema occurs when a body part swells due to an abnormal accumulation of lymph fluid, occurring when there is interference with the normal drainage of lymph fluid back into the blood, commonly swelling the arm, leg, neck or abdomen.

Phlebitis is the term used when inflammation and clotting occurs in a vein, most often a leg vein, due to infection, inflammation, or trauma. People with varicose veins are more often affected. Inflammation occurs suddenly, causing the thrombus to adhere firmly to the vein wall and risking clogging a superficial vein.

Lipodermatosclerosis is the term used to refer to the inflammation of subcutaneous fat, a form of panniculitis.

Hormones released during pregnancy and the expanding uterus (pressure on the inferior vena cava – the major vein returning blood up to the heart) can affect leg veins.

The use of lower leg compression stockings has been found to reduce symptoms and heart rate when standing upright, in patients with postural orthostatic tachycardia syndrome. Usage of compression garments on abdomen and thighs, and a combination of abdominal/thigh and leg covering compression was found to be more effective, with the latter having the most beneficial outcome.

Caution should be used in those with advanced peripheral obstructive arterial disease, heart failure, septic phlebitis, oozing dermatitis and advanced peripheral neuropathy in regard to wearing compression stockings.

First the proper size stocking is determined by measuring the legs. Aseptic technique is not necessary unless the skin is open. The person is placed in the supine position in bed for fifteen minutes prior to measuring for fit. This allows for venous return and stability before measuring. Stockings are best applied upon waking before the person has gotten out of bed, has been sitting or standing and before venous stasis or edema has had a chance to develop. Fit is critical to the therapeutic effect of compression stockings. A study listed in the American Journal of Nursing in August 2008 showed that compression stockings were incorrectly sized in just under 30% of the cases studied. It found that additional education was needed not only for patients, but also for medical staff.

The graduated (gradient, graded) compression stockings and anti embolism compression stockings come in knee high and thigh high length. A meta analysis by Sajid et al. was done to compare knee high and thigh high graded compression stockings in regards of deep vein thrombosis prevention in medical and surgical patients. The analysis determined that there was a 6% risk of developing deep vein thrombosis when wearing knee high stockings and 4% when wearing thigh high stockings, but also found significant heterogeneity, and thus it concluded that there is not enough evidence that one length is superior to the other, and suggests that knee high compression stockings should be the first choice for the deep vein thrombosis prevention in medical and surgical patients. Knee high stockings are more comfortable, easier to apply, and wearing them increases patients' compliance with treatment. Knee high stockings are easier to size for limb measurement than thigh high compression stockings. Thigh high compression stockings may create a tourniquet effect and cause localized restriction when rolled down. A study of patients treated for post thrombotic syndrome, performed in Italy, revealed that redness and itching of the skin was reported in 41% of patients wearing thigh high and 27% in patients wearing knee high compression stockings. Consequently, 22% of thigh high wearers and 14% of knee high wearers stopped the treatment.

Compression stockings are constructed using elastic fibers or rubber. These fibers help compress the limb, aiding in circulation. Compression stockings are offered in different levels of compression. The unit of measure used to classify the pressure of the stockings is mmHg. They are often sold in a variety of pressure ranges.

Use of compression therapy is not new. As early as the Neolithic period (5000 2500 BCE), images of soldiers with bandaged lower extremities were found in the drawings of the caves of Tassili in Sahara. The Edwin Smith Papyrus, which dates to roughly 1600 BCE, included additional evidence of mechanical compression therapy for legs. Hippocrates treated his patients' leg ulcers with tight bandages, which were described in his Corpus Hippocraticum (450–350 BCE). Galen (130 200 CE) used wool and linen compression bandages to prevent blood from pooling in the legs, and Oribassius (324 CE) would use tight bandages to treat leg ulcers.

There is a possible link between a common physical defect in the heart and potentially deadly stroke that could occur during long aeroplane flights. The connection, called "economy class stroke syndrome," has been reported in healthy, young travelers who had ischemic strokes during or shortly after long air trips. Prolonged sitting associated with air travel is known to be a cause of clots in the legs. Upward of 30 percent of the population is estimated to have patent foramen ovale (PFO), a common condition where a small hole exists between the right and left sides of the heart. PFO rarely causes any adverse medical condition and can be determined only through specific diagnostic tests such as an echocardiogram.