[Varicosis-Current treatment concepts]

Varicosis is a chronic progressive disease characterized by varicose veins of the lower extremities. Pain, swelling and heaviness of the legs are typical symptoms. These symptoms are caused by a pathological venous reflux, arising from a weakness of the vein wall and progressive venous insufficiency. The indications for invasive surgery are the symptomatic clinical, etiological, anatomical, pathophysiological (CEAP) stages C2s-C6. Compression therapy and venoactive drugs can be recommended for conservative therapy. When it comes to surgical treatment conventional open vein surgery is associated with the best long-term results. Endovenous thermal ablation is associated with few postoperative complications and favors earlier mobilization of the patient. Sclerotherapy has become established with good clinical results for the ablation of reticular and telangiectatic veins, for recurrences and complicated vein anatomy.

A systematic review of compression hosiery for uncomplicated varicose veins

OBJECTIVE

Compression hosiery is widely used in the prevention and management of symptoms related to varicose veins. However, there are still gaps and questions in relation to its benefit. This review seeks to examine the current evidence regarding the effectiveness of compression hosiery in the treatment of varicose veins.

METHOD

Prospective, randomized controlled trials (RCTs) evaluating compression hosiery in the treatment of varicose veins were sought. Where RCTs were unavailable other evidence was included. Studies were included if they evaluated the application of compression to patients with a diagnosis of varicose veins. Twelve electronic bibliographic databases and 18 internet-based research resources were searched. Inclusion or exclusion of trials was decided by two reviewers acting independently.

RESULTS

The search strategy identified 25 studies. Eleven were RCTs or systematic reviews, 12 non-randomized studies and two guidelines. No consensus was found regarding the class of compression needed for the effective management of varicose veins. Wearing compression improved symptom management, but could be confounded by the exclusion of high number of non-compliant patients within the trials. Wearing compression to slow the progression, or prevent the reoccurrence of varicose veins could not be supported by the current published evidence.

CONCLUSION

The evidence for the benefit of compression hosiery for varicose veins was equivocal. The published literature was often contradictory and had methodological flaws.

Compression Therapy: Effects of Posture and Application Techniques on Initial Pressures Delivered by Bandages of Different Physical Properties

OBJECTIVE

To define the pressures and gradients achieved by different bandages when applied by alternative bandaging techniques.

METHODS

An experienced bandager applied six bandages to the same leg of a volunteer using three application techniques. Pressure measurements were taken at the ankle, gaiter, calf and upper calf in three postures.

RESULTS

All bandages gave consistent pressures with all standard deviations falling below 7 mmHg. The percentage increase in pressure from resting leg to standing was inversely related to bandage elasticity. Pressures were similar at the upper calf among the bandages for each application technique in each posture (differences <10 mmHg). Small differences in pressure among the bandages (4-15 mmHg) occurred at the ankle for the resting leg with a reduction in pressure between 6 and 63% at the upper calf compared to the ankle. These differences in ankle pressure were more marked on sitting (differences 15-18 mmHg) and standing (differences 15-27 mmHg), which resulted in substantial differences in gradients.

CONCLUSIONS

Striking variations in pressures and gradients were observed between bandages of different physical properties applied using alternative application techniques. In order to achieve clinical benefits without tissue damage, it is essential that the therapist appreciates how a bandage will react with a specific application technique.

Compression Stockings Reduce Occupational Leg Swelling

BACKGROUND

Evening edema of the legs is a physiologic phenomenon occurring after sitting and standing.

OBJECTIVE

The objective of this study was to investigate which compression pressure is necessary to prevent leg swelling.

METHODS

In 12 volunteers, the volume of both lower legs was measured in the morning and 7 h later, the difference being defined as evening edema (mL). The procedure was carried out for 4 days, in which the subjects wore below-knee stockings of different compression levels alternatively on one leg only in a random order. Compression pressure was assessed using the HATRA device. RESULTS. The average evening edema of the noncompressed legs was 62.4 mL on the left side and 94.4 mL on the right side (n.s.). Evening edema was significantly reduced to 40.3 mL by light support stockings, to -34.1 mL by compression class A, to -39.6 by compression class I, and to -59.1 mL by compression class II. Mainly stockings exerting a pressure above 10 mmHg improved subjective symptoms.

CONCLUSION

Calf-length compression stockings with a pressure range between 11 and 21 mmHg are able to reduce or totally prevent evening edema and may therefore be recommended for people with a profession connected with long periods of sitting or standing.