Compression garments for varicose veins normalize blood flow, partially compensate for valvular insufficiency, relieve pain and fatigue. It is used before and after treatment of varicose veins to promote healing. They are effective in conservative and minimally invasive treatment, make the use of bandages unnecessary and enable the actual result to be achieved as predicted.
In 2018, a large-scale study was conducted on the effect of compression stockings in the conservative treatment of varicose veins. It turned out that when using the first compression class, 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 several times, large studies have been conducted since 1985.
Currently, they produce three types of compression underwear - tights, stockings of different heights and knee socks. The compression class is prescribed by a phlebologist during a personal consultation.
Flexible compression of the lower limbs is by no means new in medicine. Slaves and laborers in ancient Egypt practiced foot binding to increase stamina and performance, and legionnaires in the Roman Empire bound their feet during long walks. A similar method was used later, in the 17-19century by factory and plantation workers to speed up the healing process and reduce swelling in the limbs after a hard day.
The method of dosed external compression has also been used in medicine. The feasibility of its use in venous pathology was identified as early as the time of Hippocrates. Even then, a disease was described that was accompanied by bulging superficial veins on the legs, swelling of the affected limb and a tendency to ulceration. Bandages and compression spiral bandages were widely used for its treatment.
This technique was not forgotten. Gradually, new methods were developed to bind the limbs in the case of varicose veins and chronic venous insufficiency. Elastic compression was also used as an independent method. The most frequently used materials were cotton and knitted fabric, as well as rubber bands.
The breakthrough was the appearance of elastic binding. British entrepreneur and inventor Stephen Perry patented it in 1845 and further developed it. After that, they started producing bandages based on various materials with 3 degrees of elongation. They are still in use today. But flexible binding has several significant disadvantages.
Disadvantages of flexible binding:
- discomfort;
- the dependence of the result on the careful observance of the application technique;
- probability of uneven distribution of compaction;
- not aesthetic;
- risk of displacement of material turnovers.
In 1848, another product was patented, which gave impetus to the development of a new direction in compression therapy. William Brown invented stockings that allowed distributed circular pressure on the lower limbs. Over time, the development of light industry made it possible to manufacture pantyhose. Currently, compression stockings are recommended for various diseases affecting the veins of the lower limbs.
Classification of compression stockings
Modern compression products are available in the form of stockings, stockings of different heights and knee socks. But they are not only divided by appearance. They can also be divided into classes according to the degree of compression they provide. It is measured in millimeters of mercury.
The classification of compression products is based on the German RAL-GZ 387 standard adopted in Europe, which is the strictest and regulates the nature of pressure distribution and compliance with the physiological patterns of venous outflow, the quality and composition of materials. used.
Compression clothing can be divided into 4 classes:
Easily. Compression 18-21 mmHg.Average (medium). Compression 23-32 mm Hg.Strong. Compression 34-46 mm Hg.Very strong. Compression 49 mm Hg.
The term "tight" is sometimes used to describe compression stockings and tights. In fact, it is an incorrect substitute for "compression". This pseudo-medical preparation is based on the fact that by increasing the applied pressure, the underwear becomes less stretchy and denser to the touch. But the use of this term, and even more so the search for correspondence between the compression class and the density of ordinary tights (measured in DEN), is illiterate and fundamentally incorrect.
What is the difference between compression underwear and normal tights?
Compression stockings not only compress the soft parts of the legs. The pressure exerted by it is carefully calculated and strictly dosed, which is ensured by the use of special materials with a special fiber weave and composition. According to the RAL-GZ 387 standard, stockings and tights cannot be transparent, translucent, colored or patterned.
An important feature of compression stockings is the pressure gradient – a gradual decrease as it rises from the level of the ankle joint towards the thigh. In addition, these changes correspond to the physiological characteristics of peripheral veins and the nature of blood flow.
The greatest pressure is in the supramalleolar region. The compression starts in the upper third of the foot, touching the ankle joint - this is where the great saphenous vein originates on the medial side and its main tributaries are located here. Approximately at the level of the transition of the belly of the calf muscle to the Achilles tendon, the pressure exerted by the stockings (stockings) is already about 65-70% of the supramalleolar pressure. At the knee, 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 blood flow close to physiology.
What changes when wearing an anti-varicose compression garment?
The compression tights exert a dosed circular pressure, the extent of which is determined by the compression class. The most affected are bulging varicose veins, which develop according to Laplace's law. All other superficial veins are also compressed.
On a mechanical level:
- Reducing the diameter of the venous vessels makes it possible to reduce the amount of deposited and stagnant blood.
- Varicose vein pressure reduces the effect of valvular insufficiency and reduces blood backflow.
- It reduces the amount of horizontal reflux through the perforating vessels and increases the outflow of blood into the deep veins of the leg.
- Improving calf muscle pump function.
In general, compression stockings and stockings are symptomatic and reduce the severity of chronic venous insufficiency. Underwear provides comfort for severe varicose veins. However, we cannot speak of a cure: the patient only improves the quality of life and reduces the likelihood of complications.
Compression clothing does not eliminate varicose veins, does not restore the structure of the walls of peripheral vessels, and cannot replace surgery. It only allows for the correction of existing signs of venous insufficiency, and this effect lasts only while wearing tights/stockings.
The result of wearing compression knit underwear:
- reduction of swelling of the lower leg and ankle joint, including in the evening hours and after prolonged standing;
- a decrease in the severity of pain, which can be explained by a decrease in the degree of stagnation of venous blood and an improvement in tissue trophism;
- reducing the risk of thrombosis;
- reducing the severity of trophic disorders and reducing the likelihood of their occurrence;
- reducing the duration of the rehabilitation period after surgical interventions and minimally invasive manipulations on veins;
- reduces discomfort in the legs;
- reduces the frequency and severity of leg muscle spasms.
Wearing a compression garment is recommended for any stage of varicose veins, postphlebothrombotic syndrome (PFTS). In some cases, it is also recommended for reticular varicose veins and telangiectasia (spider veins), lower limb lymphostasis.
Particular importance is attached to post-operative compression therapy and minimally invasive endovascular procedures (EVLO, laser obliteration, RFO). Wearing special knitwear significantly increases the effectiveness of such interventions.
Indications and contraindications
Indications:
- After sclerotherapy, the better contact and then the fibrous "gluing" of the walls of the sclerotic vessel.
- Marked tissue changes due to chronic venous insufficiency (trophic ulcers, in the presence of lipodermatosclerosis).
- Phlebitis of superficial veins.
- Swelling, pain, fatigue in the legs.
- Tendency to be overweight.
Contraindications:
- clinically significant obliterating atherosclerosis of the lower limbs;
- 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 limbs;
- acute cardiovascular failure.
The ability to wear compression stockings is determined by the doctor. Changes 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?
The compression garment cannot be chosen independently, it is only prescribed by a phlebologist based on examination and ultrasound examination of the veins of the lower limbs.
Making the right choice
When choosing compression, consider the following:
- the nature and speed of venous blood flow;
- severity of abnormal vertical and horizontal 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 package of underwear contains a description of compression classes and indications for them? Can't get by in an orthopedic salon with the help of a consultant?
No, self-analysis of symptoms is not enough to choose the right compression garment: the doctor does not focus only on the degree of venous insufficiency and clinical symptoms. Other factors are also important. And the determining parameters are often age and the presence of concurrent somatic pathology: sometimes the use of a high compression class is associated with a worsening of the general condition, despite the correction of venous insufficiency.
Consider the compression level and the way you wear it
Risks of wearing compression class 3 in old age:
- Risk of stroke and heart attack.
- Severe cardiovascular failure.
Determining the treatment tactics and choosing the class and type of compression stockings is the doctor's prerogative. But the consultant of the orthopedic salon can solve the selection of the size and height of the product. It also provides detailed care instructions and teaches you how to properly put on compression stockings and tights.
Preference should be given to brands whose manufacturers follow the RAL-GZ 387 standard, which is indicated by the corresponding icon on the packaging. The standard is a guarantee of high quality, physiology and predictability.
High-quality therapeutic varicose veins shirts are not sold in pharmacies. The products are presented in orthopedic salons.
Do not save money - do not buy fakes and products from unknown manufacturers. The compression will almost certainly differ from what is declared, and the durability of the product will be low.
How to wear it and how much to wear it
We first turn the stocking inside out and fold it into a roll, then stretch it along the leg from bottom to top. This ensures proper pressure distribution and prevents product deformation. There are also special tools that make it easier to put on. They can also be purchased in orthopedic stores.
It is advisable to wear compression stockings in the morning, while still in bed: at this time, the swelling of the legs is usually minimal, so optimal compression of the veins can be achieved. We also recommend that you keep your legs elevated for a few minutes before putting on tights and "work" your legs to further increase the flow of venous blood and lymph.
Compression anti-varicose products are sometimes worn for a long time and only removed in the evening before going to bed. Such recommendations can be given, for example, in postphlebothrombotic syndrome (PFTS), thrombophlebitis and persistent edema syndrome. In other cases (in case of initial varicose veins), it is enough to wear such stockings (stockings) only during static or dynamic loading. The rules for wearing a compression garment are determined by the doctor.