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PubMed2004

Evaluation of SurePress Comfort: a new compression system for the management of venous leg ulcers.

OBJECTIVE: The primary aim was to compare the healing of venous leg ulcers after management with either a new compression stocking (SurePress Comfort, ConvaTec) or a standard short-stretch bandage system (Comprilan, BSN Medical GmbH & Co). Secondary parameters included healing rate, ease of application and removal, comfort during wear, local pain levels and concordance. METHOD: This was a prospective multicentre open-label comparative randomised controlled parallel-group pilot trial of 12 weeks' duration. RESULTS: The proportion of ulcers that healed in 12 weeks (44.4% versus 17.2%, p=0.027) and the average time to healing (72 +/- 5 days versus 101 +/- 7 days, p=0.0265) were significantly better with SurePress Comfort than the comparator. All the secondary parameters (except concordance) also showed statistically significant differences for the stocking over the comparator. CONCLUSION: SurePress Comfort stocking system is more effective than a standard short-stretch compression bandage in healing venous leg ulcers and in reducing associated pain. It is well accepted by patients due to its ease of use and comfort, and its safety profile is comparable to that of a standard compression system. It may therefore provide an effective solution for the delivery of graduated compression and has the potential to improve concordance, compared with short- stretch bandages. DECLARATION OF INTEREST: This study was sponsored by ConvaTec.

Adult↗
PubMed2004

A new anti-embolism stocking. Use of below-knee products and compliance.

This article highlights the need to use graduated compression stockings (GCS) in deep vein thrombosis (DVT) prophylaxis. A survey carried out at the Middlesex Hospital, part of the UCLH NHS Trust, London, ascertains the prevalence of patients wearing either above- or below-knee GCS and whether or not these were worn correctly through two trials. The findings show how the choice of product can influence compliance, safety and economy, which in turn influences adherence to hospital policy.

Attitude of Health Personnel↗
PubMed2000

Variations in ILMA external diameters: another cause of device failure.

PURPOSE: To report failure of insertion of #5 and #4 intubating laryngeal mask airways (ILMAs) in a patient with a mouth opening of just under 25 mm, and the variances among same-size ILMAs. CLINICAL FEATURES: A 53-yr-old man with obstructive sleep apnea underwent elective ENT surgical repair. His mouth opening was just under 25 mm. Ventilation by mask was easy. Direct laryngoscopy failed after induction of anesthesia and neuromuscular block. Neither a #5 nor a #4 ILMA could be passed between the patient's teeth, despite different twisting maneuvres. A #4 LMA was thus prepared as a conduit for fibreoptic intubation. Placement of the LMA was easy, as was fibreoptic-guided intubation. The LMA was removed over the tracheal tube (TT) to enable ENT surgery, and the further course was uneventful. Manual examination showed that, unlike others of the same type, the failed ILMAs were not sufficiently compressible either to allow insertion in this patient or to the 20 mm reported as the maximal outer dimension of the device. Radiological examination revealed that, at the point of the device where it is intended to be compressible, the silicone layer was thicker in the failed devices than in stock compressible ILMAs, and the end of the steel tube was not so sharply beveled. CONCLUSION: Our inability to insert an ILMA in a patient with an interdental distance of just under 25 mm was because the device was not sufficiently compressible although the manufacturer states the maximal outer dimension to be 20 mm.

Anesthesia↗
PubMed1997

Chronic venous insufficiency and venous ulceration.

OBJECTIVE: To review and summarize the literature on the normal venous circulation of the leg, and the epidemiology, pathophysiology, and treatment of chronic venous insufficiency (CVI). DATA SOURCES: English-language articles identified through a MEDLINE search (1966-1996) using the terms venous insufficiency or varicose ulcer and epidemiology, pathophysiology, diagnosis, and clinical trial (pt), and selected cross-references. STUDY SELECTION: Articles on epidemiology, pathophysiology, and treatment of CVI. Randomized, controlled studies were specifically sought for treatment efficacy. DATA EXTRACTION: Data were manually extracted from selected studies and reviews: emphasis was placed on information relevant to the general internist. DATA SYNTHESIS: Chronic venous insufficiency is a common primary care problem associated with significant morbidity and health care costs. The clinical spectrum of disease ranges from minor cosmetic concerns to severe fibrosing panniculitis and ulceration. Duplex Doppler ultrasonography may be the single best test to rule out deep venous thrombosis and other entities that can mimic CVI. Leg elevation and compression stockings are effective treatments for CVI; recalcitrant cases may require intermittent pneumatic compression. Topical antiseptics, antibiotics, enzymes, or growth factors offer no clear advantages in ulcer healing. Ulcer dressings remain a matter of convenience, cost, and physician judgment. The role of surgery in CVI appears to be limited. CONCLUSIONS: Chronic venous insufficiency is a recalcitrant, recurrent medical problem. This condition can be managed by primary care physicians with relatively inexpensive treatment modalities in association with lifestyle modification.

Chronic Disease↗
PubMed2006

Injection sclerotherapy for varicose veins.

BACKGROUND: Injection sclerotherapy is widely used for superficial varicose veins. The treatment aims to obliterate the lumen of varicose veins or thread veins. There is limited evidence regarding its efficacy. OBJECTIVES: To determine whether sclerotherapy is effective in improving symptoms and cosmetic appearance and has an acceptable complication rate; to define rates of symptomatic or cosmetic varicose vein recurrence following sclerotherapy. SEARCH STRATEGY: We searched the Cochrane Peripheral Vascular Diseases Group trials register (April 2006), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 2, 2006), MEDLINE and EMBASE (both inception to April 2006) and reference lists of articles. Manufacturers of sclerosants were contacted for additional trial information. SELECTION CRITERIA: Randomised controlled trials (RCTs) of injection sclerotherapy versus graduated compression stockings (GCS) or 'observation', or comparing different sclerosants, doses, formulations and post-compression bandaging techniques on people with symptomatic and/or cosmetic varicose veins or thread veins were considered for inclusion in the review. DATA COLLECTION AND ANALYSIS: Data were extracted by authors and Review Group Co-ordinators independently. MAIN RESULTS: Seventeen studies were included. One study comparing sclerotherapy to GCS in pregnancy found that sclerotherapy improved symptoms and cosmetic appearance. Three studies comparing sodium tetradecyl sulphate (STD) to alternative sclerosants found no significant differences in outcome or complication rates; another study found that sclerotherapy with STD led to improved cosmetic appearance compared with polidocanol, although there was no difference in symptoms. Sclerosant plus local anaesthetic reduced the pain from injection (one study) but had no other effects. Two studies compared foam- to conventional sclerotherapy; one found no difference in failure rate or recurrent varicose veins; a second showed short-term benefit from foam in terms of elimination of venous reflux. The recanalisation rate was no different between the two treatments. One study comparing Molefoam and Sorbo pad pressure dressings found no difference in erythema or successful sclerosis. The degree and duration of elastic compression had no significant effect on varicose vein recurrence rates, cosmetic appearance or symptomatic improvement. AUTHORS' CONCLUSIONS: Evidence from RCTs suggests that the choice of sclerosant, dose, formulation (foam versus liquid), local pressure dressing, degree and length of compression have no significant effect on the efficacy of sclerotherapy for varicose veins. The evidence supports the current place of sclerotherapy in modern clinical practice, which is usually limited to treatment of recurrent varicose veins following surgery and thread veins. Surgery versus sclerotherapy is the subject of a further Cochrane Review.

Bandages↗
PubMed2004

DVT and pulmonary embolism: Part II. Treatment and prevention.

Treatment goals for deep venous thrombosis include stopping clot propagation and preventing the recurrence of thrombus, the occurrence of pulmonary embolism, and the development of pulmonary hypertension, which can be a complication of multiple recurrent pulmonary emboli. About 30 percent of patients with deep venous thrombosis or pulmonary embolism have a thrombophilia. An extensive evaluation is suggested in patients younger than 50 years with an idiopathic episode of deep venous thrombosis, patients with recurrent thrombosis, and patients with a family history of thromboembolism. Infusion of unfractionated heparin followed by oral administration of warfarin remains the mainstay of treatment for deep venous thrombosis. Subcutaneously administered low-molecular-weight (LMW) heparin is at least as effective as unfractionated heparin given in a continuous infusion. LMW heparin is the agent of choice for treating deep venous thrombosis in pregnant women and patients with cancer. Based on validated protocols, warfarin can be started at a dosage of 5 or 10 mg per day. The intensity and duration of warfarin therapy depends on the individual patient, but treatment of at least three months usually is required. Some patients with thrombophilias require lifetime anticoagulation. Treatment for pulmonary embolism is similar to that for deep venous thrombosis. Because of the risk of hypoxemia and hemodynamic instability, in-hospital management is advised. Unfractionated heparin commonly is used, although LMW heparin is safe and effective. Thrombolysis is used in patients with massive pulmonary embolism. Subcutaneous heparin, LMW heparin, and warfarin have been approved for use in surgical prophylaxis. Elastic compression stockings are useful in patients at lowest risk for thromboembolism. Intermittent pneumatic leg compression is a useful adjunct to anticoagulation and an alternative when anticoagulation is contraindicated.

Anticoagulants↗
PubMed1997

[The effect of compression therapy on the microcirculation of the skin in patients with chronic venous insufficiency (CVI)].

Compression therapy was employed for 4 weeks 20 patients with chronic venous insufficiency stage CVI I and CVI II according to Widmer's classification. Compression bandaging for 2 weeks was followed by compression stockings for 2 more weeks. The cutaneous microcirculation was evaluated before therapy, after 2 weeks and after finishing compression therapy after 4 weeks. Marked improvement in symptoms such as pain and itching was observed after 4 weeks, along with a significant reduction in lower limb volume. Video capillary microscopy revealed an increase in capillary density associated with a decrease in capillary diameter and pericapillary halo diameter. Compression treatment achieves at least part of its effect by improving the function of the skin microcirculation. The efficacy of bandaging and stockings was similar.

Bandages↗
PubMed2004

Elastic stockings, performance and leg pain recovery in 63-year-old sportsmen.

This study was undertaken to determine whether or not elastic compression stockings (ECS) can be used in elderly sportsmen to increase performance and leg pain recovery between two maximal exercises. For 2 weeks, 12 trained elderly cyclists, 63 (3) years old, performed two 5-min maximal exercises, Plim1 and Plim2, separated by an 80-min recovery period, twice a week with a 2-day rest interval. During the 80-min recovery period, they randomly wore or did not wear grip-top ECS Ganzoni-Sigvaris. ECS exerted a 44 hPa pressure at the ankle. Blood lactate concentrations, hematocrit, and plasma volume were measured after a 60-min rest and every 20 min during recovery. Leg sensations were assessed with a questionnaire. The decrease in maximal power between Plim1 and Plim2 was lower when wearing the ECS during the 80-min recovery period; when expressed as a percentage of Plim1, the difference reached 2.1 (1.4)%, P < 0.01. Between the two exercises, blood lactate concentrations and hematocrit were significantly decreased when wearing ECS. The increase in plasma volume was not significant. The 12 cyclists stated that wearing the ECS had a positive effect on their leg pain. Ten of the cyclists thought that it could have influenced their performance. However, no relationship was found between the gain in performance and the leg pain sensation. It was concluded that wearing ECS during an 80-min recovery period significantly increased subsequent performance. This was associated with a reduction in lactate and hematocrit.

Aged↗
PubMed2005

[Compression therapy in the treatment of acute deep vein thrombosis].

Especially in Europe patients with acute deep vein thrombosis (DVT) of the leg are treated with compression therapy. A look at the literature, however, reveals that the exact mechanism of compression therapy in the treatment of acute deep vein thrombosis is not completely understood. Effects on fibrinolysis, resolution of pain and swelling as well as a fixation of the thrombus towards the vessel wall have been discussed. The literature indicates that compression stockings were mostly used in the treatment of DVT although there is some evidence that inelastic compression bandages have a greater impact on resolution of swelling and pain. Large randomised multicenter trials are still not available. Furthermore, evidence-based data providing an advantage of thigh-length compression therapy in the treatment of acute DVT are lacking. Studies have, however, shown that compression therapy is a safe therapy and can reduce the development of postthrombotic syndrome after acute DVT.

Acute Disease↗
PubMed2000

[Compression therapy in deep venous thrombosis].

External compression, both intermittent by pneumatic pumps and continuous by anelastic or elastic bandages and by graduate compression stockings, play a pivotal role in prophylaxis of Deep Venous Thrombosis (DVT). The use of external compression in DVT therapy and in prophylaxis of pulmonary embolism (PE) and of post-thrombotic syndrome has not been validated as well as in DVT prophylaxis. The pathophysiologic properties of the external compression and the most recent evidences about the early mobilization of the patients with DVT and about Low Molecular Weight Heparin (LMWH) therapy suggest the advantages of the external compression. The authors review the most important clinical investigations about early use of external compression in DVT joined with pharmacological therapy: the results have been the reduction of the growth of the thrombus, the reduction of PE ratio, the prevention of the post-thrombotic syndrome, the indirect improvement of the quality of life. Finally the authors confirm the recommendations about the use of physical therapy with early mobilization and external compression joined with LMWH anticoagulation in DVT.

Anticoagulants↗
PubMed1993

The effect of elastic stockings on the elasticity of varicose veins.

The aim of this study was to establish the long-term effect of graduated elastic compression on venous elasticity in patients with superficial or deep venous disease and to determine the possible relationship between elasticity and the duration of the disease. The elastic modulus of 29 patients, 19 with superficial vein incompetence and 10 with deep vein incompetence was assessed by the simultaneous measurement of calf volume (determined using strain gauge) and venous pressure (obtained via a dorsal foot vein) during venous occlusion. The measurements were obtained before and after 4 weeks of elastic compression stockings. The elastic modulus K, was defined as stress/strain when the veins were full and was calculated from the pressure/volume relationship. The results show a clear difference in elasticity before and after elastic stockings. Two groups of patients were identified: group 1 with increased elasticity and group 2 with decreased elasticity. There was a negative linear relationship (r = 0.88) between increase in elasticity after treatment and duration of venous disease.

Bandages↗
PubMed1998

Ultrasound-guided compression of femoral pseudoaneurysm: an audit of practice.

OBJECTIVE: To audit the practice of ultrasound-guided compression of femoral pseudoaneurysm in a specialist cardiac hospital. BACKGROUND: Femoral pseudoaneurysm is an important complication of invasive cardiac procedures. This may require surgical repair but more recently ultrasound-guided compression for ablating pseudoaneurysms has been described. We investigated the success of such a procedure. METHODS AND RESULTS: In a 26-month period, 56 patients were referred for ultrasound scanning to exclude the formation of a femoral pseudoaneurysm following transfemoral cardiac procedures. During this period, 5756 diagnostic cardiac catherisations and 1165 coronary angioplasties were performed in our hospital (total of 6921 procedures). Of the 56 patients, 20 patients (0.3% of 6921) were found to have a pseudoaneurysm. Ultrasound-guided compression was attempted in 11 patients and was successful in 7 patients (64%). Of the patients who had failed ultrasound-guided compression, 2 proceeded to surgical closure and 2 were treated conservatively with compression stockings to facilitate thrombosis of the pseudoaneurysm. Of those who did not have an attempted ultrasound-guided compression of the pseudoaneurysm (n=9), a conservative approach consisting of resting the leg was adopted to facilitate spontaneous thrombosis of the pseudoaneurysm; repeat ultrasound scanning was needed for follow-up and 1 patient required surgical closure in this group. CONCLUSIONS: In patients with a femoral pseudoaneurysm following an invasive cardiac procedure, ultrasound-guided compression may be useful as an immediate step to ablate the pseudoaneurysm. This avoids either prolonged leg rest and repeated ultrasound scanning or surgical intervention. However, ultrasound-guided compression is not always successful; in these patients, a period of conservative management with repeat ultrasound scanning is appropriate to allow for the possible spontaneous thrombosis of the pseudoaneurysm. Surgical closure is needed in those patients whose pseudoaneurysm is enlarging, painful or remain patent.

Adult↗
PubMed2004

Evidence-based compression: prevention of stasis and deep vein thrombosis.

OBJECTIVE: To summarize the currently published scientific evidence for the venous flow effects of mechanical devices, particularly intermittent pneumatic compression, and the relation to prevention of deep vein thrombosis (DVT). SUMMARY BACKGROUND DATA: While intermittent pneumatic compression is an established method of DVT prophylaxis, the variety of systems that are available can use very different compression techniques and sequences. In order for appropriate choices to be made to provide the optimum protection for patients, the general performance of systems, and physiological effects of particular properties, must be analyzed objectively. METHODS: Medline was searched from 1970 to 2002, and all relevant papers were searched for further appropriate references. Papers were selected for inclusion when they addressed specifically the questions posed in this review. RESULTS: All the major types of intermittent compression systems are successful in emptying deep veins of the lower limb and preventing stasis in a variety of subject groups. Compression stockings appear to function more by preventing distension of veins. Rapid inflation, high pressures, and graded sequential intermittent compression systems will have particular augmentation profiles, but there is no evidence that such features improve the prophylactic ability of the system. CONCLUSIONS: The most important factors in selecting a mechanical prophylactic system, particularly during and after surgery, are patient compliance and the appropriateness of the site of compression. There is no evidence that the peak venous velocity produced by a system is a valid measure of medical performance.

Bandages↗
PubMed1999

[Thrombophlebitis: bed rest or walking exercise?].

It is a common tradition to admit patients with deep vein thrombosis (DVT) to the hospital and put them to bed for several days because of fear from pulmonary embolism, even if they are mobile. Between May 1994 and December 1997 929 patients were admitted to our department who were treated by subcutaneous injections of low-molecular-weight heparin (mainly 200 IU dalteparin per kilogram body-weight per 24 hours), got firm compression bandages and were encouraged to walk as much as possible. On admission DVT propagated into the pelvis in 268 patients, into the thigh in 480 and below the popliteal level in 181 patients. V/Q-lung scans were performed at baseline and repeated after 10 days on average. In these three groups primary pulmonary embolism was diagnosed in 49.4%, 50% and 34% respectively, new emboli after 10 days were found in 6.1%, 5.7% and 3.9%. Only one third of the patients with embolism on admission and 5 from 50 patients who developed new emboli showed some dyspnoea. 12 patients died and underwent autopsy, 3 fatal events were caused by pulmonary embolism. With out management the incidence of thromboembolic complications is statistically significantly lower than data from the literature. Preliminary results from an ongoing randomised trial comparing bed-rest, compression bandages and compression stockings in the acute phase of proximal DVT demonstrate faster improvement of swelling and of pain in the compression-groups. Low-molecular-weight heparin has greatly facilitated therapy of DVT since effective anticoagulation can be obtained by subcutaneous injections of fixed doses without the need of laboratory monitoring. For the future development of conservative management mechanical prophylaxis of thrombus extension by acceleration of venous flow using leg compression and walking will probably become as important as exact anticoagulation.

Adolescent↗
PubMed2002

[A value of compression therapy prophylaxis following surgery in patients suffering from chronic venous insufficiency].

The varices of the lower limbs and its complications are very common Surgical procedure which consists of ligatur of the venous tranks or stripping of them, ligation of perforating veins are basic methods of the treatment. After surgery, veins compression prevents secondary bleeding and above all, the development or recurrence of thrombosis The purpose of this study was the assessment of graduated compression stockings in prophylaxis of varicose vein disease recurrency. The study included 120 patients who underwent phlebectomy due to varicose veins. The period of follow up lasts 3 years and has been carried out in two groups. The first one was agreed to use compression therapy following surgery. The second group did not get any physical support to their legs. Compression class I and II: calf, thigh, panty medical stockings and were used. The first group of 60 patients (102 legs) wearing medical stockings following surgery have no either subjective or objective signs of venous insufficiency in long period of time after surgery. Statistical analysis pointed out marked significance between both groups of patients p < 0.001.

Adult↗
PubMed2005

Air travel and thrombosis.

The current literature suggests a weak association between long-distance travel and the development of asymptomatic venous thromboembolism (VTE). Most of the data available relate to air travel and suggest that the risk is largely confined to asymptomatic calf vein thrombosis in passengers with additional risk factors for VTE, travelling for more than 8 h. The risk of both symptomatic and fatal pulmonary embolism (PE) is very small. The causal role of travel-related factors (e.g. stasis, dehydration, cramped seats and hypobaric hypoxia) is not yet proved but, given the plausible risk-free benefit, all passengers should be advised to maintain adequate hydration and exercise. There is currently no evidence for 'routine' thromboprophylaxis using stockings or drugs. In passengers with additional risk factors for VTE, thromboprophylaxis in the form of below-knee graduated compression stockings (providing 15-30 mmHg at the ankle) and/or prophylactic dose low-molecular-weight heparin may be considered. The evidence does not support the use of aspirin, which is associated with a significant rate of adverse gastrointestinal effects.

Aircraft↗
PubMed1998

Compression therapy with medical elastic stockings for venous diseases.

BACKGROUND: Compression therapy is the cornerstone in the treatment of venous disease. In many cases, but especially for the maintenance of compression, medical elastic compression stockings (MECS) are being used. Preprescription investigation includes determining the severity of venous insufficiency and the arterial system. An ankle/arm index < 0.6 will be the contraindication for compression therapy. MECS can be divided in flat-knitted and round-knitted MECS. Flat-knitted MECS can be made tailor sized, with a tolerance up to 0.5 cm. Several classes of MECS are characterized by the elasticity coefficient (EC) of the used elastic threads. The stiffer the stocking (high EC), the better a MECS will prevent edema formation during the day, but the more difficult it is to put them on. MECS with a high EC are always flat-knitted. Most round-knitted MECS will last 4-6 months, and flat-knitted MECS, 6-9 months. RESULTS: The physician can prescribe MECS for a wide variety of venous and some other diseases. He can determine the amount of compression as well as the stiffness of the MECS. CONCLUSION: Only a well-motivated patient and an experienced physician together are able to ensure ongoing successful compression therapy with MECS.

Ankle↗
PubMed2001

[Conservative therapy in varicose symptom complex].

This article deals with the conservative management of light and severe forms of varicosities as well as chronic venous insufficiency along with subjective symptoms and trophic skin changes. Approximately 40% of the population shows minor forms and another 10% shows major forms of varicosities. The prevalence of advanced stages of chronic venous insufficiency is approximately 3%. Compression therapy represents the mainstay of anti-edema treatment. Elastic bandages are mainly used during the acute phase, and compression stockings are rather recommended to maintain the result. The differences of short stretch and long stretch bandages, as well as the classes of compression therapy are discussed. Physical therapy, such as joint mobilization, ambulation exercises, and lymph drainage may further support edema reduction in severe cases. Edema-protective drugs can be justified as adjuvant treatment. The pharmacology and action of these substances has been further elucidated by both laboratory and clinical studies. It has been shown that the continuous use of these substances during 8-12 weeks can reach the anti-edematous effect of class II-stockings. Sclerotherapy is especially useful in the treatment of smaller caliper reticular varicosities and teleangiectatic veins. The development of new vascular lasers with a long pulse duration has added to the options in the treatment of leg teleangiectasias, although these expensive techniques cannot be regarded a standard therapy. Advanced stages of chronic venous insufficiency are also amenable to conservative treatment. In these cases, an exact vascular examination is highly recommended. Interventional treatment of relevant peripheral arterial disease and of superficial venous insufficiency can impressively improve the quality of life of these patients, even at an elderly age. Moreover, the role and differential indication of synthetic dressings in the local therapy of chronic leg ulcers is explained in-depth.

Bandages↗