Compression garments for varicose veins normalize blood flow, partially compensate for valvular deficiency, relieve pain and fatigue. It is used both before the treatment of varicose veins and to facilitate recovery. They are effective in conservative and minimally invasive treatment, eliminating the need for dressings and allowing for an actual result that matches 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 first-class 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 treatment has been repeatedly proven, large studies have been conducted since 1985.
Currently, three types of compression underwear are produced - tights, socks of various heights and knee socks. The compression class is determined by a phlebologist during a face-to-face consultation.
Elastic compression of the lower extremities is nothing new in medicine. As far back as Ancient Egypt, slaves and workers bound their feet to increase endurance and performance, and legionnaires of the Roman Empire bound their feet during long marches. A similar method was later used by factory and plantation workers in the 17th and 19th centuries to speed up recovery after a hard day's work and reduce swelling.
The dosed external compression method was also used in medicine. The expediency of its use in venous pathology was determined during the time of Hippocrates. Even then, a disease was described with bulging superficial veins in the leg, swelling of the affected limb, and a tendency to ulceration. And bandages and pressure coils were widely used for its treatment.
This technique was not forgotten. Gradually, new methods of wrapping limbs for varicose veins and chronic venous insufficiency were developed. Elastic compression has also been used as an independent method. The most common materials used 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 later improved. Subsequently, 3-degree stretch bandages based on different materials began to be produced. They are still used today. But the elastic bandage has a number of significant disadvantages.
Disadvantages of an elastic bandage:
- anxiety;
- dependence of the result on careful adherence to the application technique;
- possibility of uneven distribution of compression;
- unaesthetic;
- risk of displacement of material queues.
In 1848, another product was patented, which sparked a new trend in compression therapy. William Brown invented stockings that allowed for the application of distributed circular pressure to the lower extremities. Over time, advances in light industry allowed for the production of tights. Currently, it is a compression stocking recommended for use in various diseases affecting the veins of the lower extremities.
Classification of compression knitwear
Modern compression products are available in the form of tights, socks of various heights and knee socks. But they are not divided only by appearance. They are also divided into classes 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 RAL-GZ 387 standard adopted in Europe. It is the most rigid and regulates the nature of the pressure distribution and compliance with the physiological laws of the venous exit, the quality and composition of the materials. is used.
Compression clothes are divided into 4 classes:
Easy. Compression 18-21 mm Hg.Medium (medium). 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, this is a false substitute for the concept of "compression". This pseudo-medical formulation is based on the fact that as the level of pressure applied increases, the underwear actually stretches less and feels tighter to the touch. But using this term and 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 compression tights?
Compression socks do more than just compress the soft tissue of the feet. The pressure exerted is carefully calculated and strictly dosed, which is ensured by the use of special materials with a special touch 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 knitwear is the pressure gradient - its gradual decrease as it rises from the level of the ankle joint to the level of the thigh. Moreover, these changes correspond to the physiological characteristics of peripheral vessels and the nature of blood flow.
The greatest pressure is in the supramalleolar region. Compression begins in the upper third of the leg, surrounding the ankle joint - this is where the great saphenous vein arises from the medial side and its main branches are located. Approximately at the level of the transition of the belly of the calf muscle to the Achilles tendon, the pressure exerted by socks (tights) is already about 65-70% of the supramalleolar pressure. In the knee it is about 50%. And in the lower third of the thigh - 40% of the original.
The gradient moves in a dosed manner in the peripheral superficial veins of the lower limb and creates blood flow close to physiological.
What changes when wearing compression garments for varicose veins?
Compression seats provide dosed circular pressure, the level of which is determined by the compression class. The most affected are the bulging varicose veins that occur according to Laplace's law. All other superficial veins are also compressed.
At the mechanical level:
- Reducing the diameter of venous vessels allows to reduce the volume of accumulated and stagnant blood.
- Pressing on varicose veins helps reduce the effects of valvular insufficiency and reduce backflow of blood.
- Reducing the volume of horizontal reflux through the perforating veins, increasing the blood flow to the deep veins of the leg.
- Improving the performance of the calf muscle pump.
In general, compression tights and stockings have a symptomatic effect and reduce the severity of chronic venous insufficiency. Underwear provides relief 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 veins and cannot replace surgery. It only corrects the existing symptoms of venous insufficiency and this effect lasts only while wearing tights/socks.
Result of wearing compression knit underwear:
- reduction of swelling of the lower leg and ankle joint, including in the evening and after prolonged standing;
- decrease in pain intensity, which is explained by the decrease in the degree of venous blood stagnation and the improvement of 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 in the vessels;
- reduce discomfort in the legs;
- reduce the frequency and severity of leg muscle cramps.
Compression garments are recommended for varicose veins, postphlebothrombosis syndrome (PFTS) at any stage. In some cases, it is also recommended for reticular varicose veins and telangiectasia (spider veins), lymphostasis of the lower extremities.
Special importance is given to compression therapy after operations and minimally invasive endovascular procedures (EVLO, laser obliteration, RFO). Wearing specialized knitted clothes significantly increases the effectiveness of such interventions.
Indications and contraindications
Indications:
- For better contact and subsequent fibrous "adhesion" of the walls of the sclerosed vessel after sclerotherapy.
- Obvious tissue changes due to chronic venous insufficiency (trophic ulcers, lipodermatosclerosis).
- Phlebitis of 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 microcirculation disorders 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 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 by a phlebologist only on the basis of an examination and ultrasound examination of the veins of the lower extremities.
Making the right choice
When choosing 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 an obstruction to the outflow of blood, most often caused by thrombosis.
Many patients have a completely logical question: if the package of underwear contains a description of compression classes and instructions for them, why should you consult a doctor? Is it impossible to cope with the help of a consultant in an orthopedic salon?
No, self-analysis of symptoms is not enough for the correct selection 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 accompanying somatic pathology: sometimes the use of high-grade compression is fraught with deterioration of the general condition, despite the correction of venous insufficiency.
Observe the level of compression and the mode of wear
Risks of Class 3 compression in old age:
- Risk of stroke, heart attack.
- Severe cardiovascular failure.
It is up to the doctor to determine the treatment tactics and choose the class and type of compression stockings. But the consultant of the orthopedic salon can deal with the selection of the size and height of the product. She will also provide 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 on the packaging with the appropriate sign. The standard is a guarantee of high quality, physiology and predictability.
High-quality therapeutic anti-varicose shirt is not sold in pharmacies. Products are presented in orthopedic salons.
Do not save money - do not buy products from fake and unknown manufacturers. The compression will almost certainly be different from what is advertised and the durability of the product will be low.
How to wear and how much to wear
The sock is first turned and rolled into a roll, then rolled from bottom to top along the leg. This will ensure proper distribution of pressure and prevent deformation of the product. There are also special devices that make it easier to wear. They can also be bought in orthopedic stores.
It is advisable to wear compression stockings in the morning while you are still in bed: it is at this time that the swelling of the legs is usually minimal, so optimal compression of the veins can be achieved. It is also recommended that before putting on tights, keep your legs elevated for a few minutes and "work" your legs to further increase venous blood and lymph flow.
Anti-varicose compression products are sometimes used for a long time, removed only in the evening before going to bed. Such recommendations can be given, for example, for postphlebothrombotic syndrome (PFTS), thrombophlebitis and persistent edema syndrome. In other cases (with primary varicose veins), it is enough to wear such socks (tights) only for periods of static or dynamic loads. The rules for wearing compression garments are determined by your doctor.