Varicose vein compression garments

Compression garments for varicose veins can normalize blood flow, partially compensate for valvular insufficiency, and relieve pain and fatigue. It can be used before and after varicose vein treatment to promote recovery. They are effective in conservative and minimally invasive treatments, do not require dressings, and allow you to obtain actual results that correspond to predictions.In 2018, a large study was conducted on the effectiveness of compression stockings in the conservative treatment of varicose veins. It has been proven that when the first level of compression is used, the course of the disease is significantly slowed down and pain and swelling disappear. The positive effects of compression after surgery and minimally invasive treatments have been demonstrated many times; numerous studies have been conducted since 1985.Currently, three types of compression undergarments are produced: tights, stockings in various heights, and knee-high socks. The level of compression is prescribed by the phlebologist during a face-to-face consultation.Elastic compression of the lower limbs is by no means new in medicine. As early as ancient Egypt, slaves and workers practiced foot binding to improve endurance and performance, and legionnaires in the Roman Empire also bound their feet when walking long distances. Later, from the 17th to 19th centuries, similar methods were used by factory and plantation workers to speed up the recovery process and reduce swelling in their limbs after a hard day.Methods of quantifying external pressure are also used in medicine. The feasibility of its application in venous pathology was established as early as the time of Hippocrates. Even then, a disease was described as a bulging of superficial blood vessels in the legs, with swelling of the affected limb and a tendency to form ulcers. Bandages and pressure spiral bandages are widely used in its treatment.This technology has not been forgotten. Gradually, new methods of bandaging limbs to treat varicose veins and chronic venous insufficiency were developed. Elastic compression is also used as a stand-alone method. The most commonly used materials are cotton, knitted fabric and rubber strips.The breakthrough came with the advent of elastic bandages. In 1845, British entrepreneur and inventor Stephen Perry applied for a patent and subsequently improved it. Subsequently, the production of bandages based on various materials with an elongation of 3 degrees began. They are still in use today. But elastic bandages have a number of significant disadvantages.Disadvantages of elastic bandages:

• inconvenient;
• Results depend on careful adherence to application technique;
• The possibility of uneven compression distribution;
• Unsightly;
• Risk of material turns shifting.

In 1848, another product was patented, spurring a new direction in pressure therapy. William Brown invented stockings that applied distributed circulatory pressure to the lower limbs. Over time, advances in light industry made it possible to produce tights. Compression stockings are currently recommended for a variety of conditions affecting the veins of the lower extremities.

Classification of compression socks

Modern compression products come in the form of compression garments, stockings of various heights, and knee socks. But they differ in more than just looks. They are also divided into categories based on the degree of compression they provide. It is measured in millimeters of mercury. The classification of the pressure products used is based on the German standard RAL-GZ 387 adopted in Europe, which is the most stringent and specifies the nature of the pressure distribution and its conformity to the physiological pattern of venous outflow, the quality and composition of the materials used. Passed.Compression garments are divided into 4 categories:

• simple.Pressure 18–21 mmHg.
• Average (medium).Pressure 23–32 mmHg.
• Strong.Pressure 34–46 mmHg.
• Very strong.Compression 49 mm Hg.

The word "tight" is sometimes used to describe compression tights and stockings. In fact, it is a wrong replacement for the concept of "compression". This pseudo-medical formula is based on the fact that as the level of applied pressure increases, underwear actually becomes less elastic and denser to the touch. But using this terminology or even trying to find a correspondence between compression rating and the density (measured in DEN) of regular tights is ignorant and fundamentally wrong.

What is the difference between compression bra and regular tights?

Compression socks do more than just compress the soft tissues of your legs. The pressure it exerts is carefully calculated and strictly metered, ensured by the use of special materials with special braided threads and composition. According to RAL-GZ 387, pantyhose and stockings cannot be transparent, translucent, colored or patterned.An important feature of compression stockings is the pressure gradient - a pressure gradient that gradually decreases as the pressure rises from the ankle level 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 supra-ankle area. The compression begins in the upper third of the foot, involving the ankle joint - where the medial origin of the great saphenous vein originates, and where its main tributaries are also located. At approximately the transition point from the belly of the calf muscle to the Achilles tendon, the pressure exerted by the stocking (tights) is already approximately 65-70% of the pressure above the ankle. About 50% at the knees. Lower third of thigh - 40% of original size.The gradient acts on the superficial veins around the lower limbs in a dose manner to produce close to physiological blood flow.

What changes will occur when wearing a compression garment for varicose veins?

Compression tights exert a metered amount of cyclic pressure, the level of which is determined by the level of compression. Most affected are bulging varicose veins, which occur according to Laplace's law. All other superficial blood vessels are also compressed.At the mechanical level:

• Reducing the diameter of the veins reduces the amount of deposited and stagnant blood.
• Compression of varicose veins can help reduce the effects of valvular insufficiency and reduce the backflow of blood.
• Reduces horizontal return through perforators and increases blood flow into the deep veins of the legs.
• Improves calf muscle pump function.

In general, compression pants and stockings have a symptomatic effect and can reduce the severity of chronic venous insufficiency. Underwear brings comfort to severe varicose veins. However, we cannot talk about a cure: patients can only improve their quality of life and reduce the possibility of complications.Compression garments do not eliminate varicose veins, restore the structure of surrounding vessel walls, and are not a replacement for surgery. It only allows you to correct existing signs of venous insufficiency, and the effect only lasts while wearing tights/stockings.The effects of wearing compression knitted underwear:

• Reduce swelling of the lower legs and ankles, including at night and after standing for long periods of time;
• Reduction in pain severity due to reduced venous blood stagnation and improved tissue nutrition;
• Reduce the risk of thrombosis;
• Reduce the severity of nutritional disorders and reduce the likelihood of their occurrence;
• Shorten recovery period after venous surgery and minimally invasive procedures;
• Reduce discomfort in the legs;
• Reduce the frequency and severity of leg muscle spasms.

Compression garments are recommended for any stage of varicose veins, post-venous thrombotic syndrome (PFTS). In some cases, it is also recommended for reticular varicose veins and telangiectasia (spider veins), lymphatic stasis of the lower limbs.Of particular importance is compression therapy after surgery and after minimally invasive endovascular procedures (EVLO, laser ablation, RFO). Wearing specialized knitwear can significantly increase the effectiveness of such interventions.

Indications and Contraindications

Indications:

• After sclerotherapy, for better contact with the hardened vessel wall and subsequent "gluing" of fibers.
• Marked tissue changes due to chronic venous insufficiency (presence of trophic ulcers, lipodermatosclerosis).
• Superficial vein phlebitis.
• Leg swelling, pain, and fatigue.
• Tendency to be overweight.

Contraindications:

• Clinically significant lower extremity occlusive atherosclerosis;
• Endarteritis;
• Pustular dermatoses and microbial eczema of the lower extremities;
• bedsores;
• open wounds;
• Diabetes mellitus with endocrine polyneuropathy and signs of impaired microcirculation in the distal extremities;
• Acute cardiovascular failure.

It is up to your doctor to decide whether you can wear compression stockings. Changes in the patient's condition and the emergence of new symptoms require revisiting the phlebologist to determine further treatment strategies.

How to choose a compression product?

Compression garments cannot be chosen independently; they are specially prescribed by a phlebologist based on a lower extremity venous examination and ultrasound scan.

make the right choice

When choosing compression, you need to consider the following factors:

• the nature and velocity of venous blood flow;
• severity of pathological vertical and horizontal reflux;
• Blockage of blood flow, often caused by blood clots.

Many patients have a perfectly logical question: Why go to the doctor if the packaging of your underwear contains instructions on the compression level and its indications? Couldn’t you get by with the help of a consultant at an orthopedic salon?No, self-analysis of symptoms is not enough for the correct choice of compression garments: doctors are not only concerned with the degree of venous insufficiency and clinical symptoms. Other factors are also important. Decisive parameters are often age and the presence of concomitant somatic pathology: sometimes, despite correction of venous insufficiency, the use of advanced pressure leads to a worsening of the systemic condition.

Observe the degree of compression and how you wear it

Risks of wearing Level 3 compression garments in older adults:

• Risk of stroke and heart disease.
• Severe cardiovascular failure.

Determining the treatment strategy and selecting the category and type of compression stockings is the prerogative of the physician. But an orthopedic salon consultant can handle product size and height selection. He 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 comply with the RAL-GZ 387 standard, which will be indicated by a corresponding icon on the packaging. This standard is a guarantee of high quality, physiology and predictability.High-quality therapeutic anti-varicose vein jerseys are not sold in pharmacies. These products are displayed in orthopedic salons.Don’t save money – don’t buy fake products and products from unknown manufacturers. The compression ratio will almost certainly be different than stated, and the durability of the product will be low.

How and how much to wear

First turn the stockings inside out, fold them into a roll, and then roll them up along the legs from bottom to top. This will ensure proper pressure distribution and prevent product deformation. There are also special devices that make it easier to wear. They can also be purchased at orthopedic stores.It is recommended to wear compression stockings in the morning while lying in bed: leg swelling is usually minimal at this time, allowing optimal pressure on the veins. It is also recommended to "move" your feet by raising your legs for a few minutes before putting on tights to further increase the outflow of venous blood and lymph fluid.Compression anti-varicose vein products are sometimes worn for long periods of time and only removed at night before going to bed. Such advice may be given, for example, for postvenous thrombotic syndrome (PFTS), thrombophlebitis, and persistent edema syndrome. In other cases (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.