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PubMed1994

Influence of compression stockings on lower-limb venous haemodynamics during laparoscopic cholecystectomy.

Lower-limb venous haemodynamics were studied prospectively in 40 patients (24 women, 16 men of median age 52 years) undergoing laparoscopic cholecystectomy. Patients were randomized to wear compression stockings during surgery or no stockings. All received subcutaneous heparin prophylaxis. Venous capacitance and outflow were measured non-invasively before, during and after pneumoperitoneum. In the group without compression stockings (20 patients) venous capacitance and outflow decreased during pneumoperitoneum in most patients. In the group wearing stockings (20 patients) the changes were less pronounced or abolished. There was a significant difference between the groups in venous capacitance and outflow ratios at mid-operation: median (interquartile range) 0.89 (0.56-1.16) and 0.89 (0.56-1.15) respectively in the group without stockings versus 1.48 (1.09-2.19) and 1.71 (1.20-2.19) respectively in that with stockings (P < 0.001). Pneumoperitoneum creates a significant resistance to venous return. Compression stockings counteract the changes observed.

Adult↗
PubMed1996

[Dynamic in vivo measurements of local pressure of compression stockings with a microprobe].

Conservative treatment of chronic venous incompetence is based on compression therapy, Carried out correctly, compression therapy improves the venous return from the legs, and also relieves cutaneous congestion. These positive haemodynamic effects are, however, only obtained when the pressure exerted by the compression stocking remains within the desired therapeutic range, not only at rest, i.e. while the patient is seated or reclining, but also during exertion while the patient is standing or walking, furthermore, the pressure exerted must decrease continuously from the tips of the toes to the trunk. Using the dynamic pressure monitoring system described here, the pressure exerted by the compression stocking can be measured continuously between the stocking and the skin at any desired site. The main component of the new microprocessor-based system is a microtip probe for measuring piezoresistance. The probe has an integrated signal filter and is connected to peripheral equipment which records the measured data. The technical design of the system makes it possible accurately to record dynamic measurements of the pressure exerted by compression materials in vivo. This measuring system represents a major step forward in understanding the dynamics of compression during locomotion in vivo, and towards optimizing modern compression therapy.

Bandages↗
PubMed1996

[Compression stockings as prevention of hypotension in Cesarean section during spinal anesthesia].

Inflatable splints and wrapping of the legs have been shown to be effective against hypotension during spinal anaesthesia for Caesarean section. The aim of this study was to investigate if compression stockings could have a similar effect. Thirty healthy mothers scheduled for elective Caesarean section were randomised to have either compression stockings or no stockings on before spinal anaesthesia. The stockings had a pressure effect of 54 mmHg. The women were preloaded with 20 ml isotonic NaCl one hour preoperatively. Hypotension was defined as either a decrease in systolic blood pressure to 80% of preoperative values or systolic blood pressure under 100 mmHg. Blood pressure was measured every second minute, and ephedrine 5 mg was given in the presence of hypotension. Two patients were excluded in the control group. There were no differences in demographic data, extension of blockade, and spinal injection to delivery time. Nine patients in the group with stockings had either no fall in blood pressure or a fall in blood pressure corrected with only 5 mg ephedrine. In the control group the corresponding number was four patients (p < 0.12). Ephedrine dose between zero and 20 minutes and total ephedrine dose was significantly lower in the group with stockings than in the control group (p < 0.038). Five patients in the control group experienced nausea, no patients in the study group had nausea (p < 0.013). In conclusion, compression stockings stabilised the blood pressure during Caesarean section in spinal anaesthesia and led to a significant smaller need for ephedrine.

Adult↗
PubMed1990

Graduated compression stockings in the prevention of postoperative deep vein thrombosis.

This review examines the role of graduated elastic compression stockings in the prevention of postoperative deep vein thrombosis. Used alone compression stockings reduce the incidence of postoperative deep vein thrombosis by approximately 60 per cent and when used in combination with other preventive methods, such as low dose heparin or intermittent calf compression, they further reduce the incidence by up to 85 per cent.

Bandages↗
PubMed1991

Heparin and graduated compression stockings in patients undergoing fractured hip surgery.

Despite evidence that effective regimens are available for the prevention of venous thrombosis in fractured hip patients, many centers do not use prophylaxis. In order to evaluate the efficacy and safety of heparin and graduated compression stockings, we conducted a cohort study of 55 consecutive fractures hip patients treated postoperatively with heparin, 5,000 U every 12 h, and graduated compression stockings. The rates of venous thromboembolism and bleeding were compared with an historical cohort from Hamilton. Before discharge, 51 patients underwent bilateral venography. Deep venous thrombosis (DVT) occurred in 10 of the 51 patients (incidence of 20%); three had proximal DVT (incidence of proximal DVT was 6%). DVT was seen in 29 of the 63 control patients (incidence 46%); 19 had proximal DVT (incidence of proximal DVT was 30%). The differences in the rates of DVT and proximal DVT are statistically significant (p less than 0.01). Bleeding occurred in one patient in the treatment group (incidence 2%) and five patients in the control group (incidence 8%). This study confirms that therapy with heparin and graduated compression stockings is effective, inexpensive, and convenient for the prevention of venous thrombosis in fractured hip patients and is associated with a low bleeding risk.

Aged↗
PubMed1996

Deep vein thrombosis in lumbar spinal fusion: a prospective study of antiembolic and pneumatic compression stockings.

We prospectively studied the incidence of deep vein thrombosis (DVT) of the thigh in 117 patients having posterior lumbar spinal fusion with instrumentation and bone grafting for degenerative disk disease or spondylolisthesis. Patients with neoplasm, infection, trauma, or history of DVT were excluded. Patients were randomized into two groups. In the operating room, group 1 patients were placed in thigh-high antiembolic compression stockings (TED hose), and group 2 patients were placed in antiembolic stockings and pneumatic compression stockings. In both groups, the stockings were used until discharge. Postoperatively, patients in both groups received 600 mg buffered aspirin twice daily. Comparative analysis of the two groups showed no difference in operative time, blood loss, number of levels of lumbar vertebrae fused, time to mobilization, weight, age, or sex. All patients had duplex scanning of the thigh postoperatively. No patient in the series was observed to have acute DVT by clinical examination or by ultrasonography.

Adult↗
PubMed2002

Should knee-length replace thigh-length graduated compression stockings in the prevention of deep-vein thrombosis?

OBJECTIVE: To compare knee-length with thigh-length graduated compression stockings for correct application and rate of compliance when they are prescribed for the prevention of deep-vein thrombosis in surgical patients. METHODOLOGY: Patients who were prescribed graduated compression stockings were prospectively studied in three surgical units at Groote Schuur Hospital from February to June 1997. Knee-length stockings were prescribed in the colorectal unit, while the thigh-length variety were prescribed in the hepatobiliary and trauma units. Patients were observed for the correct application and size of stockings, and the presence of compression bands. A total of 72 patients were studied. RESULTS: One patient in the knee-length group and 7 patients in the thigh-length group were not wearing their stockings. Twenty-one of 30 patients (70%) in the knee-length group and 15 of 42 (35.7%) in the thigh-length group had correctly applied stockings (P = 0.009). CONCLUSIONS: Knee-length are more likely to be correctly applied than thigh-length stockings. Knee-length should replace thigh-length stockings in general surgical patients.

Adolescent↗
PubMed2001

Compression stockings prophylaxis of emergent varicose veins in pregnancy: a prospective randomised controlled study.

QUESTIONS UNDER STUDY: To determine the efficacy of compression stockings in preventing emergent varicose veins in pregnancy. METHODS: A prospective randomised controlled study in the outpatient department of the University Hospital of Zurich, Switzerland, including women with uncomplicated pregnancies <12 weeks at outset of study. A no-stockings control group (n = 15) was compared with two treatment groups: group 1 (n = 12) wore compression class I stockings (18-21 mm Hg) on the left leg and class II stockings (25-32 mm Hg) on the right; in group 2 (n = 15), the compression classes were reversed. Stockings were worn from study entry to term. Endpoints were emergence and worsening of superficial varicose veins, long saphenous vein reflux at the sapheno-femoral junction, and leg symptoms (pain, discomfort, cramps) during pregnancy. RESULTS: Both classes of compression stockings failed to prevent the emergence of superficial varicose veins. However, long saphenous vein reflux at the sapheno-femoral junction was observed in the third trimester in only 1/27 treated women vs. 4/15 controls (p = 0.047); in addition, more treated women reported improved leg symptoms (7/27 vs. 0/15 controls; p = 0.045). Emergent varicose changes, however, did not differ significantly (7/14 controls vs. 5/12 in group 1 and 8/14 in group 2; 3x3 table, Fisher's exact = 0.94). CONCLUSIONS: Although compression stockings do not prevent the emergence of gestational varicose veins, they significantly decrease the incidence of long saphenous vein reflux at the sapheno-femoral junction and improve leg symptoms. Our results also suggest that superficial varices and deep venous insufficiency may have a different aetiology.

Adult↗
PubMed1997

Randomised trial of effect of compression stockings in patients with symptomatic proximal-vein thrombosis.

BACKGROUND: Post-thrombotic syndrome varies from mild oedema to incapacitating swelling with pain and ulceration. We investigated the rate of post-thrombotic syndrome after a first episode of deep-vein thrombosis and assessed the preventive effect of direct application of a sized-to-fit graded compression stocking. METHODS: Patients with a first episode of venogram-proven proximal deep-vein thrombosis were randomly assigned no stockings (the control group) or made-to-measure graded compression elastic stockings for at least 2 years. Post-thrombotic syndrome was assessed with a standard scoring system that combined clinical characteristics and objective leg measurements. Patients were assessed every 3 months during the first 2 years, and every 6 months thereafter for at least 5 years. The cumulative incidence of mild-to-moderate post-thrombotic syndrome was the primary outcome measure. FINDINGS: Of the 315 consecutive outpatients considered for inclusion, 44 were excluded and 77 did not consent to take part. 194 patients were randomly assigned compression stockings (n = 96) or no stockings (n = 98). The median follow-up was 76 months (range 60-96) in both groups. Mild-to-moderate post-thrombotic syndrome (score > or = 3 plus one clinical sign) occurred in 19 (20%) patients in the stocking group and in 46 (47%) control-group patients (p < 0.001). 11 (11%) patients in the stocking group developed severe post-thrombotic syndrome (score > or = 4), compared with 23 (23%) patients in the control group (p < 0.001). In both groups, most cases of post-thrombotic syndrome occurred within 24 months of the acute thrombotic event. INTERPRETATION: About 60% of patients with a first episode of proximal deep-vein thrombosis develop post-thrombotic syndrome within 2 years. A sized-to-fit compression stocking reduced this rate by about 50%.

Bandages↗
PubMed2001

"Long haul" flight and deep vein thrombosis: a model to help investigate the benefit of aspirin and below-knee compression stockings.

OBJECTIVE: to develop a model simulating factors of "long haul" flight to investigate the relationship with DVT. MATERIALS AND METHODS: volunteers (19 males: 20 females) sat for 6 h in a warm (>25 degrees C), dry environment, limited in movement, consuming alcohol (40 ml of 40% alcohol/hour) and salted foods (300 g). Half of the subjects received 150 mg aspirin and wore especially designed below-knee, compression stockings (Class 1 profile). Changes in full blood counts were recorded, and as an indication of DVT formation, plasma was analysed for D-dimer. Limb swelling was assessed from leg measurements. RESULTS: after 6 h, in controls, there were significant rises in platelet packing (Pct p<0.04), total platelet numbers (p<0.003) and total numbers of white blood cells (WBC's p<0.001). With aspirin plus stockings, there were similar significant rises in total platelet numbers (p<0.002) and total WBC's (p<0.001). In both groups, significant rises were seen in all WBC types (except basophils). Wearing compression stockings prevented calf swelling seen in controls after 6 h (p<0.002). No subject developed a DVT, or a change in levels of D-dimer. CONCLUSION: changes in the cellular components of blood, particularly WBC's, combined with vaso-compression and reduced flow could predispose towards DVT. Aspirin, combined with compression stockings, may provide prophylaxis.

Adult↗
PubMed2006

Review on the value of graduated elastic compression stockings after deep vein thrombosis.

Graduated elastic compression stockings (GECS) are commonly used in the primary prevention of deep vein thrombosis (DVT); however, their role in preventing recurrent DVT and also post-thrombotic syndrome is less well established. The aim of this review was to investigate the effect of GECS after DVT. A literature search was performed by two independent searchers in order to identify randomised controlled trials on the effect of GECS in preventing recurrent DVT and post-thrombotic syndrome. Four randomised trials, including 537 patients, were identified. Two of the studies demonstrated that below-knee GECS significantly reduced post-thrombotic syndrome during follow-up, while a smaller study showed equivocal results. GECS reduced the incidence of post-thrombotic syndrome from 54% to 25.2% [relative risk (RR) 0.47, 95% confidence interval (CI) 0.36-0.61] with the number needed to treat (NNT) being 4 (95% CI 2.7-5.0). The rate of recurrent asymptomatic DVT was also significantly reduced by GECS (RR 0.20, 95% CI 0.06-0.64; NNT 5); the reduction in symptomatic DVT was not significant (RR 0.79, 95% CI 0.50-1.26; NNT 34). In conclusion, there is level Ia evidence to suggest that GECS can significantly reduce the incidence of post-thrombotic syndrome (PTS) after DVT, and therefore these should be routinely prescribed. The evidence for recurrent DVT is less conclusive. Further research is needed towards standardising PTS diagnostic criteria and evaluating more effective preventive measures after DVT.

Bandages↗
PubMed2006

Brief report: graduated compression stocking thromboprophylaxis for elderly inpatients: a propensity analysis.

BACKGROUND: Graduated compression stockings (GCS) are often used for deep vein thrombosis prophylaxis in nonsurgical patients, although evidence on their effectiveness is lacking in this setting. OBJECTIVE: To determine whether prophylaxis with GCS is associated with a decrease in the rate of deep vein thrombosis in nonsurgical elderly patients. METHODS: Using original data from 2 multicenter nonrandomized studies, we performed multivariable and propensity score analyses to determine whether prophylaxis with GCS reduced the rate of deep vein thrombosis among 1,310 postacute care patients 65 years or older. The primary outcome was proximal deep vein thrombosis detected by routine compression ultrasonography performed by registered vascular physicians. RESULTS: Proximal deep vein thrombosis was found in 5.7% (21/371) of the GCS users and in 5.2% (49/939) of the GCS nonusers (odds ratio [OR], 1.09; 95% confidence interval [CI], 0.64-1.84). Although adjusting for propensity score eliminated all differences in baseline characteristics between users and nonusers, the OR for proximal deep vein thrombosis associated with GCS remained nonsignificant in propensity-stratified (adjusted OR, 1.11; 95% CI, 0.59-2.10) and propensity-matched (conditional OR, 0.92; 95% CI, 0.42-2.02) analysis. Similar figures were observed for distal and any deep vein thrombosis. The rates of deep vein thrombosis did not differ according to the length of stockings. CONCLUSIONS: Prophylaxis with GCS is not associated with a lower rate of deep vein thrombosis in nonsurgical elderly patients in routine practice. Randomized studies are needed to assess the efficacy of GCS when properly used in this setting.

Aged↗
PubMed2001

Extra-strong graduated compression stocking reduces usage of vasopressor agents during spinal anesthesia for cesarean section.

Because a standard type of graduated compression stocking is not effective for the prevention of spinal anesthesia hypothension during cesarean section, we have used an extra-strong type of graduated compression stocking. This study examined whether the extra-strong stocking reduces usage of vasopressor agents. Forty-eight and 47 full term parturients were fitted with the standard stocking and the extra-strong stocking, respectively. Spinal anesthesia was performed by injecting 2.0 ml 0.3% dibucaine hyperbaric solution. When systolic blood pressure decreased to 90-100 mmHg or to less than 70% of the pre-anesthesia value, ephedrine was injected. There was no significant difference in systolic blood pressure or heart rate during spinal anesthesia between the groups. The mean dose of ephedrine injected during anesthesia was 12.2 and 4.3 mg, and the incidence of ephedrine injected was 85 and 49%, in the standard and extra-strong stocking groups, respectively. The extra-strong stocking group showed significantly lower values. Fitting the extra-strong stocking on both legs for cesarean sections undergoing spinal anesthesia reduced usage of vasopressor agents, suggesting a promising use of this stocking for non-invasive prophylaxis.

Adolescent↗
PubMed2006

Effect of elastic compression stockings on oedema prevention in healthy controls evaluated by a three-dimensional measurement system.

BACKGROUND/AIMS: The degree of oedema may differ at various sites on the leg. This study evaluated the degree of oedema at the calf, ankle and foot using a three-dimensional measurement system. METHODS: By three-dimensional measurement system using the grid pattern projection method, the effects of four different types of elastic compression stockings on oedema prevention were compared in healthy subjects. RESULTS: Without stockings, a significant increase in the circumference and volume was seen at the ankle and foot in the evening compared with morning values. The average increase in circumference was greater at the foot than that at the ankle. A significant increase in circumference and volume in the evening after a day without stockings disappeared when elastic compression stockings were worn during the day. The coefficient of variation was greater for measurements at the foot than for those at the calf and ankle. CONCLUSION: Oedema develops easily in order of the foot, the ankle and the calf in healthy populations. Elastic stockings, even with a pressure as low as 8 mmHg, are effective on oedema prevention. In measurement at the foot, further developments are necessary to improve this system.

Adult↗
PubMed1989

Prevention of thromboembolism following elective hip surgery. The value of regional anesthesia and graded compression stockings.

Ninety-eight patients scheduled for elective hip arthroplasty receiving either general or regional anesthesia and graded compression stockings as the only thromboprophylactic treatment were screened for postoperative deep-venous thrombosis with 99mTc-plasmin scintimetry. The diagnosis of deep-venous thrombosis was established by phlebography and the diagnosis of pulmonary embolism by pulmonary perfusion and ventilation scintigraphy. Of 65 patients surgically treated under general anesthesia, 20 (31%) developed deep-venous thrombosis and six developed pulmonary embolism. Of 33 patients surgically treated using regional anesthesia, three (9%) developed deep-venous thrombosis and one developed a pulmonary embolus. The number of patients developing deep-venous thrombosis was significantly lower in the group receiving regional anesthesia compared with the group receiving general anesthesia. The results indicate the beneficial effects on the incidence of postoperative thromboembolic complications following elective hip surgery from the use of regional anesthesia and graded compression stockings.

Adult↗
PubMed1995

Technical note: compression stockings and posture: a comparative study of their effects on the proximal deep veins of the leg at rest.

Graduated compression stockings have been shown to reduce the incidence of deep venous thrombosis. While they are thought to act primarily by increasing venous flow velocity, their mode of action remains uncertain. Doppler ultrasound was employed to study the relative effects of three types of support stocking on the deep venous diameter, flow velocity and pulsatility in 10 non-pregnant female subjects. In addition, the effect of altered posture on the same parameters was assessed. Significant effects of the graduated stockings were found at the level of the popliteal vein, where a reduction in both the diameter and the amplitude of respiratory phasicity was recorded (p < 0.05). No significant increase in flow velocities was recorded. Adopting the left lateral position significantly increased flow velocity in the right common femoral vein (p < 0.05). The application of stockings in this position produced no additional increase in flow velocities, but did alter the amplitude of respiratory phasicity. These data do not support the widely held view that graduated compression stockings increase flow velocities at rest. Adopting a lateral recumbent position significantly increases flow velocity in the non-dependent leg.

Adult↗
PubMed1996

Graded compression stockings for prevention of deep-vein thrombosis after hip and knee replacement.

We performed a prospective, randomised controlled trial in 177 patients who were having either total hip or knee replacement, to evaluate the use of both above- and below-knee graded compression stockings in the prevention of deep-vein thrombosis (DVT). With above-knee stockings, we found no significant reduction of the overall, proximal or major calf (> 5 cm) DVT rates. With below-knee stockings, the overall thrombosis rate was similar to that of the control group but the stockings appeared to have altered the pattern of thrombosis. Patients who had total hip replacement and wore below-knee stockings had a significantly higher rate of proximal or major calf DVT (p = 0.03). This pattern was reversed in patients with total knee replacement who developed a significantly lower rate of proximal or major calf DVT with below-knee stockings (p < 0.05). Our results showed that, with the exception of below-knee stockings in knee replacement patients, graded compression stockings were ineffective in preventing DVT after hip or knee replacement surgery.

Aged↗
PubMed2004

Graduated compression stockings reduce the venous velocity augmentation of foot pumps.

The use of the A-V Impulse System of foot pumps and graduated compression stockings to reduce the incidence of thrombo-embolic disease after total hip arthroplasty is well recognised. It is not known if they have a synergistic effect as all clinical trials have used them in combination. We examined the effect compression stockings had on the ability of the A-V Impulse System to accelerate peak venous velocities in the common femoral vein in ten healthy volunteers using a duplex scanner. The use of foot pumps without stockings produced the greatest increase in peak venous velocity and this was 34% greater than using a foot pump with stockings. It is not known if this difference could account for a reduction in thrombo-embolic episodes and so we propose a randomised clinical trial.

Arthroplasty, Replacement, Hip↗