Journal Article

Graduated compression stockings

Davies, Alun H., Lim, Chung Sim

2014

Overview

Figure 2 summarizes the mechanisms of action of graduated compression stockings. The stockings work by exerting the greatest degree of compression at the ankle, with the level of compression gradually decreasing up the garment. The pressure gradient ensures that blood flows upward toward the heart instead of refluxing downward to the foot or laterally into the superficial veins. The application of adequate graduated compression reduces the diameter of major veins, which increases the velocity and volume of blood flow.2 Graduation compression can reverse venous hypertension, augment skeletal-muscle pump, facilitate venous return and improve lymphatic drainage.3 It also initiates complex physiologic and biochemical effects involving the venous, arterial and lymphatic systems, although the exact mechanisms remain unclear.2,4,5 One study that used near-infrared spectroscopy to monitor changes in tissue oxy hemo - globin and deoxyhemoglobin re ported that limb oxygenation increased with the use of graduated compression stockings, especially with highcompression stockings.4 Another study showed that levels of proinflammatory cytokines (e.g., interleukin-1α, interleukin-6 and interferon-γ) in ulcer tissue in patients with active ulcers were significantly reduced following compression therapy.5 Although we found no RCT that compared compression with no compression in patients with venous skin changes (CEAP class C4), it is generally accepted that the management of such patients should include graduated compression stockings if tolerated.1,20 There is high-quality evidence that venous ulcers heal more rapidly with than without compression therapy.1,21,22 Patients with venous ulcers are often treated with compression bandages. However, there is some evidence that graduated compression stockings are equally effective.22,23 A meta-analysis of eight RCTs (n = 692) reported that the proportion of ulcers that healed was significantly higher with graduated compression stockings than with bandages (62.7% v. 46.6%).23 The average time to ulcer healing was also significantly shorter with the stockings, by three weeks. Graduated compression stockings may also be associated with less pain than bandages are.21,23 A systematic review of graduated compression stockings for the prevention of deep vein thrombosis in patients admitted to hospital because of conditions other than stroke identified 18 RCTs.29 Graduated compression stockings were used alone or in combination with another form of prophylaxis (e.g., heparin, acetylsalicylic acid and sequential compression). All but one of the RCTs assessed surgical patients. Deep vein thrombosis was diagnosed mostly through screening with ultrasonography, venography or isotope studies. Deep vein thrombosis developed in 13% of patients given graduated compression stockings, as compared with 26% of those with no stockings. In the trials in which stockings were given in combination with another prophylactic method, deep vein thrombosis developed in 4% of patients given the stockings plus another method, as compared with 16% of those given the other method alone. It was concluded that graduated compression stockings were effective in reducing the risk of deep vein thrombosis among patients in hospital, especially when used with another method of prophylaxis.29

• Publisher: Joule Inc,CMA Impact, Inc,Canadian Medical Association
• Subject: Care and treatment / Compression stockings / Compression therapy / Equipment Design / Health aspects / Humans / Lymphedema - therapy / Physical Therapy Modalities - instrumentation / Pressure / Pressure ulcers / Review / Side effects / Stockings, Compression / Systematic review / Treatment Outcome / Vein & artery diseases / Venous insufficiency / Venous Insufficiency - therapy / Venous Thrombosis - therapy