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Compression Therapy with Compression Stockings

Consult with Your Vein Doctor Before Buying Compression Stockings

Compression stockings are specialized elastic stockings that exert pressure against the legs and improve blood flow up the legs towards the heart. Wearing Medical Grade Compression stockings; that is, undergoing compression therapy, is a first line treatment of venous reflux or venous insufficiency. Despite the fact that compression therapy has been used to treat venous disorders since antiquity, with the earliest recording found in the Corpus Hippocraticum (450-350 BC), it was only in 1848 that William Brown patented the first elastic compression stocking.

How do Compression Stockings Work?

Compression stockings work by compressing the superficial veins that are located right under the skin and in the fat layer underneath. The pressure exerted on the surface then pushes the blood into the deep venous system that runs inside the muscles of the legs and on to the heart, reducing the pooling that occurs in spider and varicose veins. Thus, the role of compression therapy is to assist the muscle pump system of the legs, a major mechanism promoting the return of venous blood to the heart during normal locomotory activity (e.g., walking, running).



TEMPORARY IMPROVEMENT OF VENOUS BLOOD FLOW WITH COMPRESSION

The Effect of Compression on Blood Flow Pattern

Veins physically located within large leg muscle groups are alternately compressed; that is, pumped, and then decompressed as the muscles surrounding them relax. This muscle activity promotes venous return and helps lower the pressure exerted by the blood in veins and capillaries of the lower limbs. The absence of muscles around the superficial veins is one of the main reasons that these veins are more prone to become varicose than the deep veins surrounded with muscles.

Who Will Benefit from Wearing Compression Stockings?

Anyone with symptomatic vein disease, even in mild form, may benefit from wearing these stockings, whether during running errands around town or while standing and sitting for long periods. These stockings help support the legs, boost circulation and leave the patient feeling better with more energy at the end of the day. Wearing compression stockings is especially helpful when the venous valves that prevent the blood from flowing backwards do not function or are impaired as in chronic venous insufficiency.

The main benefits of wearing compression stockings include healing ulcers stemming from vein disease, and helping relieve the symptoms caused by the condition, such as aching, heaviness, tiredness, numbness and swelling in the legs. For milder cases, these symptoms may go away with compression stockings alone, and no further procedures would be necessary. Compression therapy also accelerates the circulation of blood in the legs and reduced stagnation. In this regard it is very beneficial not only in the treatment of existing blood clots in the deep and superficial system of veins, but also reducing the risk of developing blood clots in conditions that result in prolonged immobility or trauma, like major surgical procedures, long plane or car rides. It is also claimed that these stockings help slow the progression of venous reflux and prevent the varicose and spider veins from getting worse; however, these claims are not proven by the current published scientific evidence.

Note that wearing compression stockings for short duration after leg varicose vein and spider vein treatments significantly increases the success rate of the procedures and helps the healing process.

Can Compression Stockings Treat Venous Insufficiency or Varicose/Spider Veins?

Definitive treatment of venous reflux and vein disease is only achieved by closing or surgically removing these veins by using a variety of varicose vein treatment methods. These include the modern endovenous thermal ablation techniques (heating the veins shut from inside without removing them), such as radiofrequency ablation of varicose veins (VNUS or Venefit), and laser treatment of varicose veins (EVLT), in addition to complementary treatments, like Sclerotherapy, foam Sclerotherapy or Ambulatory phlebectomy. Wearing compression stockings on the other hand, offers a temporary treatment. These stockings can't eliminate varicose and spider veins and do not cure the underlying problem of leaking valves in the veins. They can; however, provide temporary relief from aches and pain associated with them, and an option for patients who are not ambulatory and, as a result, cannot engage in the activities required for the above mentioned procedures. Compression is also indicated for pregnant women whose varicose and spider veins usually disappear after delivery.

What are the Available Varieties of these Stockings?

Compression stocking intended for ambulatory vein patients are called "graduated" or "gradient" because they are specially designed to apply more pressure in the ankle area and gradually less, up the calf and thigh, thus increasing blood flow velocity within the deep venous system.


PRESSURE VARIATION IN GRADUAL COMPRESSION STOCKINGS

Pressure Variation in Gradual Compression Stockings


Graduated stockings come in many different styles and colors. They are available from several companies in a variety of fabrics and materials, strengths, lengths, and designs. The stockings are designed for both female and male use and come in knee high, thigh high and panty hose lengths and open toe and closed toe styles. With such a large selection, you're likely to find some you're comfortable wearing. In most patients, thigh high stockings are the best option, but when vein disease is restricted to the below knee area, knee high stockings would be a good alternative.


DIFFERENT STYLES OF GRADIENT COMPRESSION STOCKINGS

Different Styles of Compression Stockings


Compression pressure in these stockings is expressed in millimeters of mercury, or mmHg; the higher the number, the higher the compression. Compression levels of the "graduated" stockings could be mild (<20 mmHg), moderate (20-30 mmHg), strong (30-40mmHg) and very strong (>40 mmHg). The degree of compression is dependent on the condition being treated and underlying patient factors. The stiffer and more inelastic compression stockings have been shown to have more benefit with respect to pushing the venous blood up the leg (venous return). Hence, over the counter stockings which provide low compression do not provide adequate compression to those with vein symptoms or after vein treatment.

Where to Buy Medical Grade Compression Stockings?

High pressure compression stocking require a doctor's prescription, while stockings with low pressure are available over-the-counter. You don't need a prescription to buy compression stockings. You can buy them online, at the office of a vein specialist doctor or a phlebologist, at a medical supply store, or at a full service pharmacy. However, we discourage the purchase of compression stockings from over-the-counter retail stores or off the internet, because it is difficult to ensure the appropriate strength and fit of the stockings; moreover, the quality of the stocking is often suboptimal.

At our office we maintain a large inventory of medical grade compression stockings. Most stockings will be available to you immediately; however, occasionally, we may have to order for you the correct size and compression level. Once an order is placed, the stockings are usually delivered in a few days. Note that quality compression stockings are quite expensive (50 to 150 Dollars per pair) and most insurance companies DO NOT cover the cost of medical grade compression stockings. If your insurance covers the cost of stockings, we will provide you with all of the necessary paperwork to submit for reimbursement.

When and How to Wear Compression Stockings?

Doctors often recommend that you wear these stockings first thing in the morning and keep them on all day until bedtime. If you take a shower, you should put them on right after drying yourself up. Unless told otherwise by your doctor, you should not wear them when sleeping. If you have an ulcer from venous insufficiency, you may be asked to wear your stockings to bed to aid in healing of the ulcer. The correct size of compression stocking is also important. Incorrectly sized medical compression stockings may become uncomfortable. Watch the videos on how to put on compression stockings. Note that obese patients and patients who have difficulty moving or bending may be dependent on an assistant to help them with wearing the stockings.


HOW TO WEAR COMPRESSION STOCKINGS - OPTION 1



HOW TO WEAR COMPRESSION STOCKINGS - OPTION 2



How to Take Care of Medical Grade Compression Stockings?

Gloves are helpful in gripping the stockings. Rubber gloves usually give better grip on the fabric. As stockings tend to wear out and lose their elasticity after 3 to 6 months, they need to be replaced. You can extend the life of your stockings by reading the washing instructions carefully— hand washing and low temperatures may help them stay elastic for longer.

How to Choose the Right Compression Level?

The pressure (expressed in mmHg) of compression stockings required for therapy is determined by patient factors and the underlying disease. It is important that a vein doctor advises you of the strength most appropriate for your condition. Stockings that are too strong or too weak, may compromise their effectiveness. They should feel snug, but they should never hurt. Accordingly, change your stockings to a different size after weight loss or weight gain or when there is a change in the amount of leg swelling.

It is also recommended that you check your legs and feet for signs of blood flow problems at least once a day. If you experience prolonged numbness or tingling while wearing the stockings or notice skin that is broken, cool, pale, or purple, call your doctor. You may need a different size or strength of stocking to maintain healthy blood flow. It is also possible that you are allergic to a material used in the stockings. Elastane, nylon and Lycra are all used in varying amounts in the production of compression stockings. In quality stockings, all fibers are coated with cotton to reduce the risk of potential allergies.

Usually, pressures less than 20 mmHg are prescribed for preventing deep vein thrombosis, mild edema, tired, heavy, and aching legs (occupational leg symptoms). Pressure in the 20-30 mmHg range is prescribed for mild varicose veins, after sclerotherapy and endovenous vein treatments, for mild to moderate edema, varicose veins during and after pregnancy, and long-haul flights. Pressure in the 30-40 mmHg range is most suitable for venous ulcers (including healed ulcers), mild lymphoedema, deep-vein-thrombosis, post-thrombotic syndrome and varicose veins with severe edema and/or skin changes. Finally pressures larger than 40 mmHg are prescribed for severe chronic venous insufficiency and severe lymphoedema. At our vein center, Dr. Dishakjian will measure your legs and tell you what type of stockings are right for you.

Can Compression Heal Leg Ulcers?

Chronic venous insufficiency (venous reflux) is the most common cause of lower extremity ulceration, accounting for more than three quarters of the approximately 2.5 million leg ulcer cases in the United States; ischemic ulceration is less common. Recurrence rates of venous ulcers are high, with two thirds of patients experiencing one or more recurrences.

Currently, compression therapy with graduated bandaging is the 'gold standard' for the management of venous ulceration, both as an active treatment for healing of ulcers and having an essential role in the prevention of ulcer recurrence. It is reported that healing rates as high as 95 percent can be achieved in patients who are compliant. It should be pointed out that ensuring concordance is extremely important in the prevention of ulcer recurrence. Despite this fact, many patients cannot tolerate these graduated bandaging. These are often prescribed below-knee graduated compression hosiery with an appropriate primary dressing. Compression bandaging is often too bulky for these patients, or difficult to handle. Talk to your doctor about the compression stockings or bandaging systems that are right for you.

Who Should Not Wear Compression Stockings?

Patients with moderate or severe peripheral arterial disease (PAD) should not wear compression stockings. In these patients, compression may be dangerous and even cause gangrene or loss of the leg. Peripheral arterial disease (PAD) refers to decreased blood flow into the legs resulting in poor delivery of oxygen and nutrients. Note also that compression therapy may result in heart failure in patients when a lot of fluid is pushed back to their heart. Diabetic patients; on the other hand, should regularly examine their legs for symptoms of poor blood flow, and only wear socks made specifically for those having diabetes and circulatory problems.

 

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Nu Vela Esthetica
A review of compression medical stockings intended for vein therapy. Ask Dr. Raffi Dishakjian, M.D., the vein specialist of the Los Angeles vein center, Nu Vela Esthetica, about the compression stockings suitable for your vein symptoms.


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