Compression garments for varicose veins normalize blood flow, partially compensate for valve insufficiency and relieve pain and fatigue. It is used both before the treatment of varicose veins and after to facilitate recovery. They are effective in conservative and minimally invasive treatment, eliminate the need for medications and allow you to obtain a real result corresponding to the expected 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 using the first class of compression, the course of the disease slows down significantly, pain and swelling disappear. The positive effect of compression after surgical and minimally invasive treatment has been demonstrated several times; extensive studies have been conducted since 1985.
Three types of compression underwear are currently produced: pantyhose, stockings of various heights and knee-high socks. The compression class is prescribed by a phlebologist during a face-to-face consultation.
Elastic compression of the lower limbs is not at all new in medicine. In ancient Egypt, slaves and workers practiced foot binding to increase stamina and performance, while legionaries of the Roman Empire bound their feet during long hikes. A similar method was used later, in the 17th-19th centuries, by factory and plantation workers to speed up the recovery process and reduce swelling of the limbs after a hard day.
The metered external compression method has also been used in medicine. The feasibility of its use in venous pathology was identified as early as the time of Hippocrates. Already then, a disease was described with the presence of superficial vessels, swelling on the leg, swelling of the affected limb and a tendency to the formation of ulcers. And for its treatment, pressure spiral bandages and bandages were widely used.
This technique has not been forgotten. Gradually, new methods of limb bandaging for varicose veins and chronic venous insufficiency were developed. Elastic compression has also been used as an independent method. The most used materials were cotton, knitted fabric and rubber strips.
The turning point was the appearance of an elastic bandage. It was patented in 1845 by British entrepreneur and inventor Stephen Perry and subsequently improved. Subsequently, bandages with 3 degrees of stretch based on various materials began to be produced. They are still in use today. But elastic bandaging has a number of significant disadvantages.
Disadvantages of an elastic bandage:
- unease;
- dependence of the result on careful adherence to the application technique;
- the probability of a non-uniform distribution of compression;
- unsightly;
- risk of movement of the coils of material.
In 1848, another product was patented, which gave impetus to the emergence of a new direction in compression therapy. William Brown invented stockings that allowed circular pressure to be exerted on the lower limbs. Over time, advances in light industry made the production of pantyhose possible. And currently, it is compression hosiery that is recommended for use in various diseases affecting the veins of the lower extremities.
Classification of compression stockings
Modern compression products are available in the form of tights, stockings of various heights and knee-highs. But they are not divided only by appearance. They are also divided into classes based on the degree of compression they provide. It is measured in millimeters of mercury.
The classification of the compression products used is based on the German standard adopted in Europe RAL-GZ 387. It is the most severe and regulates the nature of the pressure distribution and its conformity with the physiological patterns of venous outflow, the quality and composition of the materials used.
Compression garments are divided into 4 classes:
- Easy.Compression 18–21 mmHg.
- Medium (moderate).Compression 23–32 mmHg.
- Strong.Compression 34–46 mmHg.
- Very strong.Compression 49 mmHg.
The term "tightness" is sometimes used to describe compression tights and stockings. This is in fact an incorrect replacement of the concept of "compression". This pseudomedical formulation is based on the fact that with an increase in the level of applied pressure, the underwear actually becomes less elastic and denser to the touch. But using this term, and even more so looking for a correspondence between the compression class and the density of normal tights (measured in DEN), is illiterate and fundamentally wrong.
What is the difference between compression underwear and regular tights?
Compression hosiery doesn't just compress the soft tissues of the legs. The pressure it exerts is carefully calculated and strictly dosed, which is ensured by the use of special materials with a special texture of threads and composition. According to the RAL-GZ 387 standard, tights and stockings cannot be transparent, translucent, colored or patterned.
An important feature of compression hosiery is the pressure gradient, its gradual decrease as one rises from the level of the ankle joint to the thigh. Furthermore, these changes correspond to the physiological characteristics of peripheral veins and the nature of blood flow.
The greatest pressure is in the supramalleolar region. Compression begins in the upper third of the foot, involving the ankle joint: this is where the great saphenous vein originates on the medial side and its main tributaries are located. Approximately at the level of the transition of the belly of the calf muscle to the Achilles tendon, the pressure exerted by stockings (tights) is already about 65-70% of the supramalleolar pressure. At the knee it is about 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 limb and creates a blood flow close to the physiological one.
What changes when wearing compression garments for varicose veins?
Compression tights exert a dosed circular pressure, the level of which is determined by the compression class. The most affected are protruding varicose veins, which occur according to Laplace's law. All other superficial vessels are also pressed.
On a mechanical level:
- Reducing the diameter of the venous vessels allows you to reduce the volume of deposited and stagnant blood.
- Pressure on varicose veins helps reduce the effect of valve insufficiency and reduce the return flow of blood.
- By reducing the volume of horizontal reflux through the perforating vessels, increasing blood flow in the deep veins of the leg.
- Improve the functioning 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, we cannot speak of a cure: the patient only improves the quality of life and reduces the probability of complications.
Compression garments do not eliminate varicose veins, do not restore the structure of the walls of peripheral vessels and cannot replace surgery. It only allows you to correct existing signs of venous insufficiency and this effect only lasts by wearing tights/stockings.
The result of using compression knitted underwear:
- reduction of swelling of the lower leg and ankle joint, including in the evening and after prolonged standing;
- reduction in the severity of pain, which is explained by a decrease in the degree of stagnation of venous blood and an improvement in tissue trophism;
- reduce the risk of thrombosis;
- reduce the severity of trophic disorders and reduce the likelihood of their occurrence;
- reduce the duration of the rehabilitation period after surgical interventions and minimally invasive manipulations on the veins;
- reduce the feeling of discomfort in the legs;
- reducing the frequency and severity of leg muscle cramps.
It is advisable to wear compression garments for varicose veins of any stage, postphlebothrombotic syndrome (PFTS). In some cases it is also recommended for reticular varicose veins and telangiectasias, lymphostasis of the lower limbs.
Particular importance is given to postoperative compression therapy and minimally invasive endovascular procedures (EVLO, laser obliteration, RFO). Wearing specialized knitwear significantly increases the effectiveness of such interventions.
Indications and contraindications
Directions:
- After sclerotherapy for better contact and subsequent fibrous "gluing" of the walls of the sclerosing 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 obliterating atherosclerosis of the lower extremities;
- endarteritis;
- pustular skin diseases of the lower extremities and microbial eczema;
- bedsores;
- open wounds;
- diabetes mellitus with signs of endocrine polyneuropathy and impaired microcirculation in the distal extremities;
- acute cardiovascular failure.
The possibility of wearing compression stockings is 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 garments cannot be chosen independently; they are prescribed exclusively by the phlebologist on the basis of an examination and ultrasound of the veins of the lower limbs.
Make the right choice
When choosing compression, the following are taken into account:
- the nature and speed of venous blood flow;
- severity of vertical and horizontal pathological reflux;
- the presence of an obstruction to the outflow of blood, which is most often caused by thrombosis.
Many patients have a completely logical question: why go to the doctor if the packaging of underwear contains a description of compression classes and related indications? Is it not possible to get by with the help of a consultant in an orthopedic salon?
No, self-analysis of symptoms is not sufficient for the correct choice of compression garments: the doctor does not focus only on the degree of venous insufficiency and clinical symptoms. Other factors are also important. And the determining parameters often become age and the presence of concomitant somatic pathology: sometimes the use of a high class of compression is fraught with a worsening of the general condition, despite the correction of venous insufficiency.
Observe the level of compression and how it is worn
Risks of using class 3 compression in old age:
- Risk of stroke, heart attack.
- Severe cardiovascular insufficiency.
Determining treatment tactics and selecting the class and type of compression stockings is the prerogative of the doctor. But the choice of size and height of the product can be made by the consultant of the orthopedic salon. He will also give you detailed care instructions and teach you how to properly wear compression tights and stockings.
Preference should be given to brands whose manufacturers are guided by the RAL-GZ 387 standard. This will be indicated by the corresponding icon on the packaging. The standard is a guarantee of high quality, physiology and predictability.
High-quality anti-varicose therapeutic shirt is not sold in pharmacies. The products are presented in orthopedic salons.
Don't save money: don't buy counterfeit products and products from unknown manufacturers. The compression will almost certainly be different than stated and the product life will be low.
How to wear and how much to wear
The sock is first unrolled and folded into a roll, then rolled along the leg from bottom to top. This will ensure correct pressure distribution and prevent product deformation. There are also special devices that make it easier to put on. They can also be purchased in orthopedic stores.
It is recommended to wear compression stockings in the morning while in bed: this is when swelling in the legs is usually minimal, so that optimal compression of the veins can be achieved. It is also advisable, before putting on tights, to keep your legs raised for a few minutes and to "work" your feet to further increase the outflow of venous blood and lymph.
Anti-varicose compression products are sometimes worn for a long time and only removed in the evening before bed. Such recommendations can be given, for example, for postphlebothrombotic syndrome (PFTS), thrombophlebitis and persistent edematous syndrome. In other cases (with initial varicose veins), it is enough to wear such stockings (tights) only for periods of static or dynamic load. The rules for wearing compression garments are established by the doctor.