Compression garments for varicose veins normalize blood flow, partially compensate for valve insufficiency, and relieve pain and fatigue. It is used both before and after the treatment of varicose veins to facilitate recovery. They are effective in conservative and minimally invasive treatment, eliminate the need for bandages and allow you to get a real result that corresponds to the intended 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 proven many times; large studies have been conducted since 1985.
Currently, three types of compression underwear are produced - pantyhose, socks of various heights and knee socks. The compression class is prescribed by a phlebologist during a face-to-face consultation.
Elastic compression of the lower extremities is by no means new to medicine. Back in Ancient Egypt, slaves and laborers practiced foot binding to increase endurance and performance, and Roman Empire legionnaires bound their feet during long marches. 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 method of dosed external compression was also used in medicine. The feasibility of its use in venous pathology was traced back to the time of Hippocrates. Even then, a disease was described with the presence of dilated superficial vessels in the leg, swelling of the affected limb, and a tendency to ulceration. And for its treatment bandages and spiral pressure bandages were widely used.
This technique was not forgotten. New methods of bandaging limbs for varicose veins and chronic venous insufficiency were gradually developed. Elastic compression was also used as an independent method. The most commonly used materials were cotton and knitted fabric 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. Subsequently, bandages of 3 degrees of elongation began to be produced based on various materials. They are still in use today. But the elastic bandage has a number of significant disadvantages.
Disadvantages of an elastic bandage:
- bother;
- dependence of the result on the careful observance of the technical application.
- the possibility of uneven distribution of compression.
- unsightly;
- risk of shifting material turns.
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 distributed circular pressure to be applied to the lower extremities. Over time, the advancement of light industry made it possible to produce pantyhose. And currently, it is the compression stocking that is recommended for use in various diseases that affect the veins of the lower extremities.
Classification of compression socks
Modern compression products are available in the form of tights, socks of various heights and knee socks. But they are not separated only by appearance. They are also divided into categories according to the degree of compression they provide. It is measured in millimeters of mercury.
The classification of compression products used is based on the German standard RAL-GZ 387 adopted in Europe. It is the most strict and regulates the nature of the pressure distribution and its compliance with the physiological patterns of venous outflow, the quality and composition of the materials used.
Compression garments are divided into 4 categories:
Comfortably. Compression 18–21 mm Hg.Moderate (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 an incorrect replacement of the concept of "compression". This pseudo-medical formulation is based on the fact that by increasing the level of pressure applied, the underwear actually becomes less elastic and denser to the touch. But using this term, and even more so trying to look for a correspondence between the compression class and the density of ordinary tights (measured in DEN) is illiterate and fundamentally wrong.
What is the difference between compression underwear and regular tights?
The compression sock does more than compress the soft tissue of the feet. The pressure it exerts is carefully calculated and strictly dosed, which is ensured by the use of special materials with a special knitting of threads and composition. According to the RAL-GZ 387 standard, tights and socks cannot 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 characteristics of the peripheral veins and the nature of the blood flow.
The greatest pressure is in the supramallicular area. The compression begins in the upper third of the leg, which includes the ankle joint - this is where the great saphenous vein originates on the medial side and its main tributaries. Approximately at the level of the transition of the belly of the calf muscle to the Achilles tendon, the pressure exerted by the socks (tights) is already about 65–70% of the suprapubic 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 dose manner on the peripheral superficial veins of the lower extremity and creates a near-normal blood flow.
What changes when you wear compression garments for varicose veins?
Compression tights exert dosed circular pressure, the level of which is determined by the compression class. The most affected are varicose veins, which appear according to Laplace's law. All other superficial vessels are also compressed.
On a mechanical level:
- Reducing the diameter of the venous vessels allows you to reduce the volume of deposited and stagnant blood.
- Varicose compression helps reduce the effect of valvular insufficiency and reduce backflow of blood.
- Reduction of the volume of horizontal reflux through perforated vessels, increase of blood outflow in the deep veins of the leg.
- Improving calf muscle pump function.
In general, compression tights and stockings have a symptomatic effect and reduce the severity of chronic venous insufficiency. Underwear creates comfort for severe varicose veins. However, we cannot talk about treatment: the patient only improves the quality of life and reduces the likelihood 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 when wearing pantyhose/socks.
The result of using knitted underwear with compression:
- reduction of swelling of the lower leg and ankle joint, even at night and after a period of prolonged standing.
- decrease in the severity of pain, which is explained by the decrease in the degree of venous blood stagnation and the improvement of tissue trophism.
- reducing the risk of blood clots.
- reducing the severity of eating disorders and reducing the likelihood of their occurrence.
- reducing the duration of the recovery period after surgical operations and minimally invasive manipulations in the veins.
- reducing the feeling of discomfort in the legs.
- reducing the frequency and severity of leg muscle cramps.
The use of compression garments is recommended for varicose veins of any stage, postphlebothrombotic syndrome (PFTS). In some cases, it is also recommended for reticular varicose veins and telangiectasias (spiders), lymphostasis of the lower extremities.
Particular importance is given to compression therapy after operations and minimally invasive endovascular procedures (EVLO, laser obliteration, RFO). The use of specialized knits significantly increases the effectiveness of such interventions.
Indications and contraindications
Indications:
- After sclerotherapy for better contact and subsequent fibrous "gluing" of the walls of the hardened vessel.
- Intense tissue changes due to chronic venous insufficiency (presence of trophic ulcers, lipodermasclerosis).
- Phlebitis of superficial veins.
- Swelling, pain, tiredness in the legs.
- Tendency to be overweight.
Contraindications:
- clinically significant neutralizing 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 reduced microcirculation in the distal extremities.
- acute cardiovascular failure.
The ability to wear compression stockings is determined by your doctor. A change in the patient's condition and the appearance of new symptoms requires 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 a venologist based on an examination and ultrasound of the veins of the lower extremities.
Making the right choice
When choosing compression, consider the following:
- the nature and speed of venous blood flow;
- severity of pathological vertical and horizontal regression;
- the presence of obstruction to blood flow, which is most often caused by thrombosis.
Many patients have a perfectly reasonable question: why go to the doctor if the package of underwear contains a description of compression classes and indications for them? Is it not possible to cope with the help of a consultant in an orthopedic institute?
No, self-analysis of symptoms is not enough 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 simultaneous physical pathology: sometimes the use of a high class of compression is fraught with worsening of the general condition, despite the correction of venous insufficiency.
Note the compression level and wear mode
Risks of using class 3 compression in old age:
- Risk of stroke, heart attack.
- Severe cardiovascular failure.
Determining regular treatment and choosing the category and type of compression stockings is the doctor's prerogative. But the consultant of an orthopedic salon can handle the selection of the size and height of the product. He will also give detailed care instructions and teach you how to properly wear the tights and compression 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 package. The standard is a guarantee of high quality, normality and predictability.
High-quality therapeutic anti-varicose flannel is not sold in pharmacies. The products are presented in orthopedic institutes.
Do not save money - do not buy imitations and products from unknown manufacturers. Compression will almost certainly differ from stated and product durability will be low.
How to wear and how much to wear
The sock is first turned and folded into a roll, and then wrapped along the leg from bottom to top. This will ensure proper pressure distribution and prevent product distortion. There are also special devices that facilitate its placement. They can also be purchased at orthopedic stores.
It is recommended to wear compression stockings in the morning while you are still in bed: at this time the swelling of the legs is usually minimal, so that optimal compression of the veins can be achieved. It is also recommended that before putting on the tights, you hold your legs up for a few minutes and "work" your legs to further increase venous blood and lymph flow.
Compression products against varicose veins are sometimes worn for a long time, removed only at night before going to 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 socks (tights) only for periods of static or dynamic loads. The rules for using compression garments are determined by your doctor.