Compression stockings for varicose veins normalize blood circulation, partially compensate for valve insufficiency and relieve pain and fatigue. It is used both before varicose vein treatment and after to facilitate recovery. They are effective in conservative and minimally invasive treatment, eliminating the need for bandages and allowing you to achieve an actual result equivalent to the predicted one.
In 2018, a large study was conducted on the effect of compression stockings in the conservative treatment of varicose veins. It turned out that when the first class of compression is used, the course of the disease slows down significantly, pain and swelling disappear. The positive effect of compression after surgical and minimally invasive treatments has been widely proven; large studies have been carried out since 1985.
Currently, three types of compression underwear are produced: tights, stockings of different heights and knee-highs. The compression course is prescribed by a phlebologist during a personal consultation.
Elastic compression of the lower extremities is by no means new in medicine. In ancient Egypt, slaves and workers practiced footbinding to increase endurance and performance, and legionnaires of the Roman Empire bound their feet during long walks. A similar method was later used by factory and plantation workers in the 17th and 19th centuries to speed up the recovery process and reduce swelling of the limbs after a strenuous day.
The method of dosed external compression was also used in medicine. The feasibility of its use in venous pathology was already recognized at the time of Hippocrates. Even then, a disease with bulging superficial vessels on the leg, swelling of the affected extremity and a tendency to ulcer formation was described. And bandages and pressure coil bandages were often used to treat it.
This technique has not been forgotten. Gradually, new methods of bandaging limbs for varicose veins and chronic venous insufficiency were developed. Elastic compression was also used as an independent method. The most commonly used materials were cotton, knitted fabrics and rubber strips.
The breakthrough was the appearance of an elastic bandage. It was patented in 1845 by British entrepreneur and inventor Stephen Perry and subsequently improved. They then began producing bandages with 3 degrees of stretch based on different materials. They are still in use today. But elastic bandages have a number of significant disadvantages.
Disadvantages of an elastic bandage:
- Inconvenience;
- Dependence of the result on careful adherence to the application technology;
- the likelihood of uneven compression distribution;
- unaesthetic;
- Danger of material coils shifting.
In 1848, another product was patented that provided the impetus for a new direction in compression therapy. William Brown invented stockings that made it possible to apply distributed circular pressure to the lower limbs. Over time, advances in light industry enabled the production of pantyhose. And currently compression stockings are recommended for use in various diseases of the veins of the lower extremities.
Classification of compression stockings
Modern compression products come in the form of tights, stockings of various heights and knee socks. But they are divided by more than just their looks. They are also divided into classes based on the level of compression they provide. It is measured in millimeters of mercury.
The classification of the compression products used is based on the German standard RAL-GZ 387 adopted in Europe. It is the strictest and regulates the type of pressure distribution and its compliance with the physiological patterns of venous outflow, the quality and composition of the materials used.
Compression clothing is divided into 4 classes:
- Simply.Compression 18-21 mm Hg.
- Average (moderate).Compression 23-32 mm Hg.
- Strong.Compression 34-46 mm Hg.
- Very strong.Compression 49 mm Hg.
The term "tightness" is sometimes used to describe compression tights and stockings. In fact, it is a misnomer for the term "compression. "This pseudo-medical formulation is based on the fact that as pressure increases, underwear actually becomes less stretchy and tighter. But the use of this term, and even more so the attempt to find a connection between the compression class and the density of ordinary tights (measured in DEN) is illiterate and fundamentally incorrect.
What is the difference between compression underwear and regular tights?
Compression stockings not only compress the soft tissue of the legs. The pressure applied is carefully calculated and strictly dosed, which is ensured by the use of special materials with a special thread weave and composition. According to RAL-GZ 387, tights and stockings must not be transparent, translucent, colored or patterned.
An important feature of compression stockings is the pressure gradient - its gradual decrease as it rises from the level of the ankle joint to the thigh. In addition, these changes correspond to the physiological properties of the peripheral veins and the nature of blood flow.
The greatest pressure is in the supra-alleolar area. The compression begins in the upper third of the foot and affects the ankle joint - this is where the great saphenous vein and its main tributaries arise on the medial side. At approximately the level of the transition from the calf belly to the Achilles tendon, the pressure exerted by stockings (tights) is already around 65-70% of the supramalleolar pressure. At the knee it is around 50%. And in the lower third of the thigh – 40% of the original.
The gradient acts in a dosed manner on the peripheral superficial veins of the lower extremities and creates a physiological blood flow.
What changes when wearing compression clothing for varicose veins?
Compression tights apply a measured circular pressure, the amount of which is determined by the compression class. The most affected are the prominent varicose veins, which occur according to Laplace's law. All other superficial vessels are also pressed.
On a mechanical level:
- Reducing the diameter of venous vessels allows you to reduce the volume of deposited and stagnant blood.
- Squeezing varicose veins helps reduce the effects of valve insufficiency and reduces blood backflow.
- Reducing the volume of horizontal reflux through perforating vessels, increasing blood outflow into the deep veins of the legs.
- Improving the function of the calf muscle pump.
In general, compression tights and stockings have a symptomatic effect and reduce the severity of chronic venous insufficiency. Lingerie creates comfort for severe varicose veins. However, there can be no talk of a cure: the patient only improves the quality of life and reduces the likelihood of complications.
Compression stockings do not eliminate varicose veins, do not restore the structure of the walls of peripheral vessels and cannot replace surgery. It only allows correction of the existing signs of venous insufficiency and this effect only lasts when wearing tights/stockings.
The result of wearing compression knit underwear:
- Reduction of swelling of the lower leg and ankle, even in the evening and after standing for a long time;
- Reduction in the intensity of pain, which is explained by a reduction in the degree of venous blood stagnation and improved tissue trophy;
- reducing the risk of thrombosis;
- Reducing the severity of trophic disorders and reducing the likelihood of their occurrence;
- Reducing the rehabilitation time after surgical interventions and minimally invasive procedures on the veins;
- reducing discomfort in the legs;
- Reducing the frequency and severity of cramps in the leg muscles.
Wearing compression clothing is advisable for varicose veins of any stage, post-phlebothrombotic syndrome (PFTS). In some cases it is also recommended for reticular varicose veins and telangiectasias (spider veins), as well as for lymphostasis of the lower extremities.
Compression therapy is particularly important after operations and minimally invasive endovascular procedures (EVLO, laser obliteration, RFO). Wearing special knitwear significantly increases the effectiveness of such procedures.
Indications and contraindications
Hints:
- After sclerotherapy for better contact and subsequent fibrous "gluing" of the walls of the sclerotic vessel.
- Pronounced tissue changes due to chronic venous insufficiency (in the presence of trophic ulcers, lipodermatosclerosis).
- Phlebitis of the superficial veins.
- Swelling, pain, fatigue in the legs.
- Tendency to be overweight.
Contraindications:
- clinically significant obliterative atherosclerosis of the lower extremities;
- endarteritis;
- pustular skin diseases of the lower extremities and microbial eczema;
- pressure ulcers;
- open wounds;
- Diabetes mellitus with signs of endocrine polyneuropathy and impaired microcirculation in the distal extremities;
- acute cardiovascular failure.
Suitability for wearing compression stockings will be determined by your doctor. A change in the patient's condition and the appearance of new symptoms require a second consultation with a phlebologist to determine further treatment tactics.
How to choose a compression product?
Compression clothing cannot be selected independently; it is prescribed exclusively by a phlebologist on the basis of an examination and ultrasound of the veins of the lower extremities.
Make the right choice
When selecting compression, the following are taken into account:
- the nature and speed of venous blood flow;
- severity of pathological vertical and horizontal reflux;
- the presence of obstruction to blood outflow, most often caused by thrombosis.
Many patients have a completely logical question: why go to the doctor if the underwear package contains a description of compression classes and their indications? Isn't it possible to get by with the help of a consultant in an orthopedic salon?
No, self-analysis of the symptoms is not enough for the correct selection of compression clothing: the doctor does not focus only on the degree of venous insufficiency and the clinical symptoms. Other factors are also important. And the determining parameters are often age and the presence of concomitant somatic pathology: sometimes the use of a high class of compression is associated with a deterioration in the general condition, despite correction of venous insufficiency.
Pay attention to the degree of compression and the way you wear it
Risks of wearing compression class 3 in old age:
- Risk of stroke, heart attack.
- Severe cardiovascular failure.
The doctor is responsible for determining the treatment tactics and selecting the class and type of compression stockings. But the consultant of an orthopedic salon can take care of the selection of the size and height of the product. He also gives you detailed care instructions and shows you how to put on compression tights and stockings correctly.
Brands whose manufacturers follow the RAL-GZ 387 standard are preferred. This is indicated by the corresponding symbol on the packaging. The standard is a guarantee of high quality, physiology and predictability.
High-quality therapeutic anti-varicose vein jerseys are not sold in pharmacies. The products are presented in orthopedic salons.
Don't skimp - don't buy fakes and products from unknown manufacturers. The compression will almost certainly differ from that stated and the durability of the product will be poor.
How to wear and how much to carry
The stocking is first turned out, folded into a roll and then rolled out along the leg from bottom to top. This ensures proper pressure distribution and prevents product deformation. There are also special devices that make dressing easier. You can also buy them in orthopedic stores.
It is recommended to wear compression stockings in bed in the morning: At this point, the swelling in the legs is usually minimal, so that optimal compression of the veins can be achieved. It is also recommended to hold your legs up and "work" your feet for a few minutes before putting on the tights to further increase the outflow of venous blood and lymph.
Compressants for varicose veins are sometimes worn for a long period of time and only removed in the evening before going to bed. Such recommendations can be made, for example, for postphlebothrombotic syndrome (PFTS), thrombophlebitis and persistent edematous syndrome. In other cases (in the case of initial varicose veins), it is enough to wear such stockings (tights) only during static or dynamic loads. The rules for wearing compression garments are determined by your doctor.