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PubMed2003

[Effect of elastic stockings on edema related to chronic venous insufficiency. Videocapillaroscopic assessment].

AIM: To evaluate the effect of class II (23-32 mm Hg) compression stockings on the edema of the ankle in patients with chronic venous insufficiency (CVI), and to assess the relationship between the microvascular phenomenon and the volume of the leg. MATERIAL AND METHOD: 11 patients (19 limbs, 5 women and 6 men, mean age 57 years) with CVI, CEAP 2-3 were studied through physical examination, Doppler color ultrasound test, measurement of leg volume and videocapillaroscopy. Patients were evaluated before (T0), after 7 days (T1) and 14 days (T2) of daily compression therapy with elastic stockings. Statistical comparisons used the Mac Nemar test for binomial variables and Wilcoxon test for paired quantitative data. RESULTS: All patients experienced significant improvement of symptoms, the volume of the limbs on the average decreased in the first week T0-T1=284.8 cm(3) +/- 307.5 cm(3) (6.27%, p<0.001). During the second week a small increase in volume was observed T2-T1=+ 12.23 cm(3), NS, 0.29%). The width of the capillary halo of edema decreased during the first week by an average of T0-T1=5.77 microm +/- 10.99 microm. During the second week the width of the edema halo continued diminishing, although in smaller proportion (T0-T2=7.89 microm +/- 11.77 microm). CONCLUSION: Daily use of grade II compression stockings induces a reduction in leg volume in patients with CEAP grades 2-3. This improvement of edema is paralleled by a decrease in the size of the pericapillary halo.

Bandages↗
PubMed2006

Above-knee versus below-knee stockings in total knee arthroplasty.

INTRODUCTION: Graduated compression stockings are frequently used following arthroplasty surgery for deep vein thrombosis (DVT) prophylaxis. There are often strongly held beliefs regarding whether below-knee or above-knee stockings should be used in total knee joint replacement. Many surgeons argue that below-knee stockings are more likely to induce wound complications because of increased swelling above the stocking and the elastic causing localised pressure on the wound. PATIENTS AND METHODS: This study is a prospective comparison of above and below-knee stockings in patients undergoing total knee joint replacement. A total of 50 patients were recruited and studied - 23 patients in the above-knee stocking group and 24 in the below-knee group. Swelling around the knee was measured over the course of an in-patient stay, together with wound complication rates and patients' preference. RESULTS: No statistical difference was found between the groups and no difference in wound complication rates was determined. CONCLUSIONS: Below-knee stockings are safe following total knee replacement and are preferred by patients.

Aged↗
PubMed2003

[Obstetrics and gynecology].

Pregnancy has been recognized as a predisposing risk factor of deep venous thrombosis(DVT) and pulmonary thromboembolism(PTE). Recently, we investigated the incidence of PTE between 1991 and 2000 among 64 facilities of Obstetrics and Gynecology in Japan. As a result, incidences of PTE are 0.006% (14/227,318) in cases of vaginal delivery and 0.046%(25/54,277) in cases of cesarean section (CS) in Obstetrics. In Gynecology, they are 0.03% (34/106,598) in patients of benign tumors and 0.33%(54/16,206) in patients of malignant tumors. Classification of level of risks in Japanese subjects at present is thought to be as follows; cases of normal delivery and minor surgery are low risk, cases of CS and benign gynecological tumors are moderate risk, cases of CS with elderly fatty pregnant women and gynecological malignant tumors are high risk, and cases of CS or malignant tumors with thrombophilia or pre-DVT are the highest risk. Prophylaxis of DVT should be recommended early ambulation and adequate hydration in low risk cases, graduated compression stocking (GCS) or intermittent pneumatic compression (IPC) in moderate risk cases, IPC or the use of low-dose unfractionated heparin(LDUH) (and/or GCS) in high risk cases, and LDUH and IPC or LDUH and GCS in the highest risk cases.

Female↗
PubMed2005

External compression increases forearm perfusion.

Application of compression stockings to the lower extremities is a widely used therapeutic intervention to improve venous return, but there is little information about the effects of compression on local arterial perfusion. Therefore, we tested the hypothesis that a positive external pressure increases forearm perfusion. The relation of increasing external pressure induced by standardized compression to the arterial inflow and arterial flow reserve of the forearm was critically evaluated in a group of healthy young men (n = 9). Flow was measured with venous occlusion plethysmography after a 10-min application of six different stockings with compression pressure increasing from 13 to 23 mmHg. During compression, the arterial inflow increased significantly from 3.7 +/- 0.85 to 8.8 +/- 2.01 ml.min(-1).100 ml tissue(-1) (P < 0.001) and the arterial flow reserve increased from 17.7 +/- 4.7 to 28.3 +/- 7.0 ml.min(-1).100 ml tissue(-1). The flow increase was persistent after 3 h of constant application of external pressure and also during simultaneous low-intensity hand grip. Similar results obtained with occlusion plethysmography were seen with MRI. During the interventions, forearm temperature was unchanged, and the volunteers reported no discomfort. In conclusion, 1) arterial perfusion of the human forearm increases more than twofold during application of external compression over a pressure range of 13-23 mmHg, and 2) the result is interpreted as an autoregulatory response following the decrease of the vascular transmural pressure gradient.

Adult↗
PubMed2002

Klippel-Trenaunay syndrome.

The association of three physical findings including capillary malformation, varicosities, and hypertrophy of bony and soft tissues corresponds to Klippel-Trenaunay syndrome. This triad of findings, described by the two French physicians Klippel and Trenaunay in 1900, differs from Parkes-Weber syndrome, in that Klippel-Trenaunay syndrome does not incorporate significant hemodynamic arteriovenous fistulas. Generally, management of this disease process should be individualized. Surgery should be considered in cases where skin ulcerations lead to persisting and recurrent bleeding, or where digital deformities lead to functional disabilities or where significant limb overgrowth leads to both functional and psychological impairment. Persistent hematochezia, hematuria, and vaginal and esophageal bleeding are considered indications for surgical intervention. Recurrent attacks of thrombophlebitis and cellulitis are treated medically with antiinflammatory agents and antibiotics. Otherwise, management of this syndrome is generally conservative, consisting of psychological encouragement, reassurance, and the continued use of graduated compressive stockings for varicosities and intermittent pneumatic compression pumps for lymphatic edema.

Adult↗
PubMed1993

Deep venous thrombosis following posterior lumbar spinal surgery.

Postoperative duplex scans were performed on 185 patients undergoing posterior lumbar spinal surgery in order to identify deep venous thrombosis (DVT). Elastic compression stockings were used for prophylaxis in 74 patients (Group E.S.); intermittent pneumatic compression was used in the remaining 111 patients (Group P.C.). High-risk patients were not eliminated from either group. Laminectomy was performed on 84 patients (40 from Group E.S. and 44 from Group P.C.), and spinal fusion, on 101 patients (34 from Group E.S. and 67 from Group P.C.). A total of four patients, all from Group E.S., developed acute postoperative DVT. Intermittent pneumatic compression significantly reduced the incidence of acute postoperative DVT (P < 0.05). No statistically significant differences were found in the incidence of DVT in relation to the type of spinal procedure, length of procedure, duration of bed rest, or age of the patient. In conclusion, considering the low rate of DVT (2%) following posterior lumbar surgery and the potential complications of prophylactic anticoagulation, we continue to use intermittent pneumatic compression rather than elastic stockings for prophylaxis.

Adult↗
PubMed2000

Management of venous edema: insights from an international task force.

An International Task Force made up of a panel of 16 experts has reviewed and objectively evaluated all aspects of chronic venous disease of the leg (CVDL). All available publications on CVDL from 1983 to 1997 were identified through computerized search in Medline and by a manual search. Next, three different screenings were performed in order to select only relevant papers providing a level of scientific evidence that was considered moderate to strong. Final conclusions and further therapeutic recommendations were made based on these publications. Medication, compression, local therapy, sclerotherapy, and surgery are the accepted available therapeutic options for CVDL. For edema, the following recommendations can be made: edema is an early sign of CVDL, but before starting any treatment, nonvenous causes of edema should be excluded. Medication and compression are the therapeutic options for edema that are accepted by the Task Force. Evaluation of their efficacy is based on objective measures of edema. Several well-conducted, placebo-controlled trials have shown efficacy of drugs such as micronized purified flavonoid fraction, rutosides, calcium dobesilate, and coumarin rutin. Graduated compression stockings have been shown to be effective; compression needs to be exerted at least at 35 mm Hg. Bandages, if properly applied, both fixed and stretched, can produce favorable results. Sclerotherapy or surgery is not indicated unless there is saphenofemoral or saphenopopliteal reflux. In the absence of such reflux or following deep venous thrombosis, there is no evidence to support sclerotherapy or surgery.

Anticoagulants↗
PubMed1999

Efficacy of prophylaxis against thromboembolism with intermittent pneumatic compression after primary and revision total hip arthroplasty.

BACKGROUND: Thromboembolism is a common and important complication after total hip arthroplasty. A variety of pharmacological and mechanical measures have been proposed for prophylaxis. The purpose of the present study was to evaluate the efficacy of intermittent pneumatic compression as prophylaxis against thromboembolism following total hip arthroplasty. METHODS: The prospective study involved a consecutive series of 425 patients in whom a total of 502 (324 primary and 178 revision) total hip arthroplasties had been performed by two surgeons. The patients were managed intraoperatively and postoperatively with use of thigh-high elastic compression stockings and thigh-high intermittent pneumatic compression sleeves. Experienced vascular technologists performed venous duplex ultrasonography on both lower extremities of all patients at a mean of six days (range, two to fifteen days) postoperatively. All patients were followed for at least one year in order to detect late thromboembolism. RESULTS: An asymptomatic deep-vein thrombosis was noted on the scans made after twenty-three (4.6 percent) of the 502 procedures. Nineteen (3.8 percent) of the arthroplasties were followed by the development of a proximal thrombosis and four (0.8 percent), a distal thrombosis. Nineteen of the thromboses were ipsilateral (eighteen were proximal and one, distal), and four were contralateral (one was proximal and three, distal). No symptomatic deep-vein thrombosis developed in the hospital. In addition, three (two proximal and one distal) symptomatic ipsilateral deep-vein thromboses (a prevalence of 0.6 percent) developed three to twenty-three weeks after postoperative scans revealed negative findings and the patients were discharged from the hospital. Three symptomatic pulmonary embolisms (a prevalence of 0.6 percent) were confirmed by ventilation-perfusion scanning while the patients were in the hospital. There were no symptomatic pulmonary embolisms after discharge, and there were no fatal pulmonary embolisms. With the numbers available, we were unable to detect an association between deep-vein thrombosis and age (p = 0.76), gender (p = 0.13), body-mass index (p = 0.12), type of arthroplasty (primary or revision) (p = 0.12), operative approach (p = 0.37), duration of the operation (p = 0.21), type of anesthesia (general or regional) (p = 0.51), units of blood transfused (autologous, p = 0.79; homologous, p = 0.57), blood type (p = 0.18), or the presence of a so-called classic risk factor for the development of thrombosis (p = 0.22). Five arthroplasties (1.0 percent) were followed by the development of a wound hematoma, but only one hematoma necessitated operative drainage. CONCLUSIONS: The use of intraoperative and postoperative thigh-high intermittent pneumatic compression, combined with duplex ultrasonography performed by experienced vascular technologists, is effective for prophylaxis against thromboembolism after both primary and revision total hip arthroplasties. The low prevalence of deep-vein thrombosis (4.6 percent) and symptomatic pulmonary embolism (0.6 percent) is comparable with that associated with pharmacological prophylaxis.

Arthroplasty, Replacement, Hip↗
PubMed1976

[Compression treatment in venous and lymphatic flow disorders of the leg].

Based on our investigations, the mode of action of compression bandages is discussed ant the physiological and physical principles of this therapy are reviewed. The different basic forms of compression therapy, for example, non-elastic bandages, elastic bandages, use of foam rubber and sponge rubber inserts as well as compression stockings, are mentioned. The side effectes of compression therapy are treated and the indications for compression therapy in superficial and deep thromboses, postthrombotic syndrome and lymphedema are discussed.

Bandages↗
PubMed2001

Thromboembolism after total knee arthroplasty: intermittent pneumatic compression and aspirin prophylaxis.

This is a study of two consecutive antithromboembolism regimens after total knee arthroplasty. In group 1, 131 patients were given aspirin prophylaxis alone (650 mg by mouth twice a day). In group 2, 123 patients were treated with aspirin, knee-high compression stockings, and intermittent knee-high pneumatic compression devices, which were started intraoperatively. The prevalence of deep vein thrombosis in group 1 was 15.9% (21 of 131 patients). One patient had a possible symptomatic nonfatal pulmonary embolism, and one patient had a symptomatic calf thrombus. Asymptomatic thrombi were detected in calf veins in 9 patients, popliteal vein in 6 patients, and femoral vein in 5 patients. In Group 2, the prevalence was 7.4% (9 of 123 patients). Asymptomatic thrombi were located in calf veins in 6 patients, popliteal vein in 1 patient, and femoral vein in 2 patients. There was a significant difference in the prevalence of deep vein thrombosis between the two groups. A history of previous thromboembolism was a significant risk factor for a new thrombus. The prevalence after bilateral one-stage knee arthroplasty was 24.3% for group 1 and 12.5% for group 2. Aspirin and knee-high intermittent pneumatic compression together are more effective than aspirin alone for prevention of deep vein thrombosis after primary and revision knee arthroplasty.

Adult↗
PubMedDate not supplied

Nursing care for the prevention of deep vein thrombosis.

1. Deep vein thrombosis (DVT) and pulmonary embolism (PE) are major health problems that often result in significant postsurgical morbidity and mortality. 2. To prevent DVT, patient care includes graduated compression stockings or the use of a pneumatic compression device, and administration of the correct dose of anticoagulation agent (heparin or LMWH). 3. Taken together, the various drug therapies and physical interventions can clearly prevent DVT. Careful evaluation of the patient's risk factors, along with a monitored postoperative therapy can minimize the morbidity and mortality of this "unseen" condition.

Anticoagulants↗
PubMedDate not supplied

Risk factors and prevention of venous thromboembolism.

In the last 20 years within the clinical research on venous thromboembolism a major objective was to identify and develop increasingly effective and safe methods of prevention. This trend is justified by the high incidence of thromboembolism as well as by the relevant mortality for acute pulmonary embolism and postphlebitic sequels of difficult treatment. A significant contribution to the rational application of methods of prevention was given by the knowledge of risk factors. Together with acquired risks, as surgery, age, malignant tumors, in the last 30 years some conditions of thrombophilia were identified. They are caused by deficiencies in coagulation inhibitors (antithrombin III, protein C, protein S) or other alteration of the anticoagulation system as resistance to activated protein C or antiphospholipid antibodies. The primary prophylaxis of venous thromboembolism is aimed at the prevention of thrombosis by pharmacologic methods able to oppose the procoagulant alterations while avoiding hemorrhagic complications. The physical methods tend to reduce the stasis in the veins of the lower extremities. Subcutaneous calcium heparin at the dose of 5000 U twice or three times a day is the most common pharmacologic method used. It was shown to be safe and effective especially in postoperative prophylaxis of venous thromboembolism in general surgery. More recently, low molecular weight heparin fractions have been introduced. As compared to standard heparin they have the advantage of a single daily dose and a better efficacy in some groups of patients, as those undergoing hip replacement. Among the substances under clinical experimentation, dermatan sulfate seems promising. Most common physical prevention methods consist in the use of elastic graduated compression stockings and systems of intermittent pneumatic calf compression. The former can be used also in presence of a hemorrhagic risk as in neurosurgery. The latter have shown a good efficacy in increasing flow velocity and probably also in enhancing the fibrinolytic activity. The combination of physical and pharmacologic methods seems to be able of enhancing the efficacy of prophylaxis.

Anticoagulants↗
PubMed2005

Thromboembolic disease prophylaxis in total hip arthroplasty.

UNLABELLED: We sought to determine if using aspirin and exercise as prophylaxis against thromboembolic disease in patients having total hip arthroplasties would provide results as effective as or better than those reported in the literature using other chemical agents. One thousand eight hundred thirty-five total hip arthroplasties were done in 1585 patients using a posterior approach. Surgery was done with the patient under general anesthesia in 459 instances and regional anesthesia in 1376 instances. Graduated elastic stockings were used in 1117 instances and intermittent compression stockings were used in 718 instances. Passive exercises of the major joints of the operated extremity were done intraoperatively, and active exercises were done postoperatively. Patients received a suppository containing 10 grains of aspirin immediately after surgery and 325 mg twice a day for the length of their hospitalization. Fatal pulmonary embolism developed after two (0.10%) surgical procedures. Nonfatal pulmonary embolisms were diagnosed in 17 (0.9%) patients, and deep venous thrombosis was diagnosed in 17 (0.9%) patients. The low incidence of thromboembolic complications recorded in this series suggests that our postoperative protocol, including 325 mg of aspirin twice a day during hospitalization and exercise, is an effective and inexpensive method of prophylaxis after total hip arthroplasty. LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series--no, or historical control group). See the Guidelines for Authors for a complete description of levels of evidence.

Arthroplasty, Replacement, Hip↗
PubMed1999

[Value of compression therapy in treatment of deep venous thrombosis].

Therapy in the acute phase of deep vein thrombosis aims to prevent the longitudinal growth of the thrombus as well as the life-threatening complication of pulmonary embolism. Compression therapy is part of all revascularisative and conservative treatment strategies, but hardly mentioned in most of the literature. Clinical efficacy of a sufficient compression therapy in patients with acute deep vein thrombosis is marked by a quick ease of subjective complaints as well as a reduction of the edema. The long-term risk of deep vein thrombosis, the postthrombotic syndrome, is avoidable by the use of compression therapy. Clinical studies about the effectiveness in relation to the length of the thrombus and the incidence of pulmonary embolism are missing as well as studies about the selection of the best compression material. Recently compression pressures were experimentally measured between long and short stretch bandages and the skin in order to select bandage material. It can be concluded that long stretch bandages can be used in the treatment of acute phlebothrombosis in mobile out-patients. Short stretch bandages should be used in immobile patients in order to avoid high pressures between the skin and the bandages. Compression stockings (Class III) represent an equivalent alternative to compression bandages after the resolution of edema.

Acute Disease↗
PubMed1997

Electrical stimulation-induced contraction to reduce blood stasis during arthroplasty.

Deep venous thrombosis and subsequent pulmonary embolism due to venous pooling/stasis commonly occur in patients during hip and/or knee arthroplasty (i.e., replacement). This problem may be alleviated by using techniques to promote lower limb blood flow. Electrical stimulation-induced contractions have been shown to activate the skeletal muscle pump, promote limb blood flow, and may be effective for reducing venous pooling/stasis and edema. Therefore, electrical stimulation may reduce the incidence of deep venous thrombosis (DVT) and pulmonary embolism (PE) during and following surgery. The overall goal of this project was to evaluate the clinical efficacy of sequential electrical stimulation-induced leg muscle contractions on the venous blood flow during surgery. The degree of venous pooling/stasis was monitored via electrical impedance changes in the thorax. The changes in the patient's central hemodynamics were then calculated. Thirty patients were recruited and randomly assigned to either a control group (n = 15, mean age = 66.4 +/- 7.3) or experimental group (n = 15, age = 60.7 +/- 9.7). Both groups received the standard medical treatment for prevention of DVT (i.e., coumadin, heparin, etc.) and compression stockings (TED, Kendall). The control group used the sequential compression device (SCD + TED) and the experimental group used electrical stimulation (ES + TED). Electrical stimulation was applied via surface electrodes to the lower-limb muscles (tibialis anterior and gastrocnemius) and upper limb muscles (quadriceps femoris and hamstrings). These muscles contracted sequentially, using an eight-channel electrical stimulator. Four seconds of calf (contraction/compression) were followed by 7-s of calf and thigh (contraction/compression) interspersed by 60-s rest period during both electrical stimulation or sequential compression device. This cycle continued throughout the surgery (60-75 min) for both groups. At 15 min intervals, venous return was monitored by impedance cardiograph. Physiologic responses including ventricular stroke volume (SV), cardiac output (CO), heart rate (HR), total peripheral resistance (TPR), as well as mean arterial pressure (MAP) were monitored. These responses were statistically analyzed and compared throughout the surgery within each group and between the two groups. The results show stroke volume and cardiac output to be higher throughout surgery in the electrical stimulation group as compared with the sequential compression device group. The heart rate was consistently lower during electrical stimulation for both groups. Total peripheral resistance did not change in the electrical stimulation group; but increased in the sequential compression device group. The data suggest that continuous electrical stimulation-induced contractions could improve lower leg circulation by eliciting the physiologic muscle pump. This will lead to improved venous circulation and reduction of blood stasis during total hip and/or knee surgery. This technique may offer greater protection against DVT and PE during surgery than the commonly used sequential compression device.

Bandages↗
PubMed2003

Leg compression and ambulation is better than bed rest for the treatment of acute deep venous thrombosis.

AIM: Treatment of acute deep venous thrombosis (DVT) with low-molecular-weight heparin and vitamin K-antagonists reduces the risk of thrombus progression and pulmonary embolism but has no immediate effect on signs and symptoms. We addressed the question whether adding compression and walking would lead to a more rapid clinical improvement than bed rest. METHODS: Fifty-three symptomatic outpatients with proximal DVT were randomly treated, in addition to dalteparin and phenprocoumon, with either firm inelastic bandages (n=18), elastic compression stockings (n=18), both combined with immediate deliberate ambulation, or bed rest without any compression (n=17). We assessed daily walking distance, well-being, quality of life, pain, swelling and clinical scores over a period of 9 days. Lung scans and ultrasound of the leg were performed on days 0 and 9. RESULTS: In the compression groups the walking distance increased with time to 4 km/day on average. Improvement of well-being and DVT-related quality of life was significantly faster and more pronounced with compression than with bed rest (p<0.05 for stockings, p<0.001 for bandages). Pain monitored by visual analogue scale decreased with time in a linear pattern in all groups (p<0.001). There was a significant difference between the groups (p<0.01), the best effect being achieved with bandages. Pain assessed by a provocation test was reduced by half on day 3 with bed rest but remained constantly present over the subsequent 6 days. With compression it was reduced to near baseline on day 3. Swelling was almost completely removed with compression and clinical scores also improved more than with bed rest (p<0.001). Thrombus progression, as studied with ultrasound, was less frequent and less pronounced in the compression groups than with bed rest. There was no difference of new pulmonary embolism on repeat lung scans. CONCLUSION: Leg compression combined with walking is the better alternative to bed rest for the treatment of symptomatic outpatients with proximal DVT.

Acute Disease↗