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A Journal on Phlebology
Acta Phlebologica 2013 August;14(2):67-71
Effects on venous hemodynamics of therapeutic elastic stockings with different compression profiles
Arpaia G. 1, Mosti G. 1, Spezzigu G. 1, Ippolito E. 1, Milani M. 1, Chraim A. 2
1 Angiology Unit, Hospital of Desio and Vimercate Vimercate, Milan, Italy;
2 Lviv Regional Clinical Hospital Department of Vascular Surgery, Lviv, Ukraine
Aim: Elastic or non-elastic hosiery with compression decreasing from the ankle to the calf or thigh is one of the basic approaches for treating the various forms of chronic venous insufficiency and lymphedema. Early in this century the first reports were published on the effects on the hemodynamics of muscle veins in athletes of elastic stockings providing “progressive” compression. Subsequently French investigators demonstrated the “non-inferiority” and later confirmed the superiority on secondary endpoints of comfort and compliance, and on medium-short-term symptoms. Most recently reports demonstrated the superiority of progressive elastic hosiery on objective variables in patients with severe superficial venous insufficiency; using strain-gauge plethysmography they showed there was a stronger effect on muscle ejection fraction at the calf. There are still no studies showing how stockings with different compression profiles affect venous hemodynamics in deep-vein pathologies.
Methods: Between March and September 2012, in the course of routine follow-up visits, 30 patients who had had deep venous thrombosis in a leg in the two previous years agreed to a series of photoplethysmographic examinations (Photoplethysmograph Microlab Doppler System II); static and dynamic examinations were performed, at baseline conditions and wearing commercially available stockings with different compression profiles. We compared stockings with graduated compression, class 2 according to the GGG-Ral standards (A), with hosiery specially designed for use during sport, with greater compression at the calf than the ankle, which our group had tested earlier (B).
Results: The percentages of venous emptying during muscle activity were significantly lower than baseline when patients wore the hosiery, and significantly lower with stocking B than with stocking A.
Conclusion: Our findings suggest that the hemodynamic profile is influenced more by higher compression at the calf, even when the deep venous circulation is involved. It remains to be seen whether the different compression profiles of the therapeutic elastic hosiery really influence “long-term” the clinical course or symptoms of patients with venous insufficiency, and if so, which of the various forms of this condition, and lesion sites, might benefit most.