Compression garments for varicose veins normalize blood flow, partially compensate for valvular insufficiency, relieve pain and fatigue. It is used both before and after 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 predicted one.
In 2018, a large-scale study was conducted on the effect of compression hosiery 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 repeatedly proven, large-scale studies have been conducted since 1985.
Currently, three types of compression underwear are produced - tights, socks of different heights and knee socks. The compression class is prescribed by a phlebologist during a personal consultation.
Elastic compression of the lower limbs is nothing new in medicine. As far back as Ancient Egypt, slaves and laborers practiced foot binding to increase endurance and productivity, and Roman legionnaires bound their feet during long walks. A similar method was used later, in the 17th-19th centuries, by workers in factories and plantations to speed up the recovery process and reduce swelling of the limbs after a hard day.
The method of dosed external compression is also used in medicine. The possibility of its use in venous pathology was identified as early as the time of Hippocrates. Even then, a disease was described with the presence of bulging superficial vessels of the leg, swelling of the affected limb and a tendency to ulceration. And for its treatment, pressure bandages and spiral bandages are widely used.
This technique was not forgotten. Gradually, new methods were developed for bandaging limbs in varicose veins and chronic venous insufficiency. Elastic compression is also used as an independent method. The most commonly used materials are cotton and knitted fabrics and rubber bands.
The breakthrough was the appearance of an elastic bandage. It was patented in 1845 by British entrepreneur and inventor Stephen Perry and subsequently improved upon. Subsequently, bandages with 3 degrees of elongation began to be produced based on different materials. They are still used today. But elastic bandaging has a number of significant drawbacks.
Disadvantages of the elastic bandage:
- inconvenience;
- the dependence of the result on the careful observance of the application technique;
- the probability of uneven distribution of compression;
- unaesthetic;
- risk of displacement of material bends.
In 1848, another product was patented, which gave impetus to the emergence of a new trend in compression therapy. William Brown invented stockings that allowed distributed circular pressure on the lower limbs. Over time, advances in light industry made it possible to manufacture pantyhose. And currently, compression hosiery is recommended for use in various diseases affecting the veins of the lower extremities.
Classification of compression hosiery
Modern compression products come in the form of tights, socks of different heights and knee socks. But they are divided not only in 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 the 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 classes:
easy. Compression 18–21 mm Hg.Average (moderate). Compression 23–32 mm Hg.Strong. Compression 34–46 mm Hg.Very strong. Compression 49 mm Hg.
The term "tightening" is sometimes used to describe compression tights and stockings. In fact, it is an incorrect substitute for the term "compression". This pseudo-medical formulation is based on the fact that as the level of applied pressure increases, the underwear actually becomes less stretchy and tighter to the touch. But using this term and even more so trying to look for 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?
Compression hosiery not only compresses the soft tissues of the legs. The pressure it exerts is carefully calculated and strictly dosed, which is ensured by the use of special materials with a special fabric of the 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 hosiery is the pressure gradient - its gradual decrease when rising from the level of the ankle joint to the thigh. Moreover, these changes correspond to the physiological characteristics of the peripheral veins and the nature of the blood flow.
The pressure is greatest in the supramalleolar region. Compression begins in the upper third of the foot, including the ankle joint - it is here on the medial side that the great saphenous vein begins and its main tributaries 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. At the knee it is about 50%. And in the lower third of the thigh - 40% of the original.
The gradient has a dosed effect on the peripheral superficial veins of the lower limb and creates blood flow close to physiological.
What changes when wearing a compression garment for varicose veins?
The compression pantyhose exerts a dosed circular pressure, the level of which is determined by the compression class. The most affected are the bulging varicose veins, which is obtained according to Laplace's law. All other superficial vessels are also pressed.
On a mechanical level:
- Reducing the diameter of the venous vessels allows you to reduce the volume of deposited and stagnant blood.
- Compression of varicose veins helps reduce the effect of valvular insufficiency and reduce backflow of blood.
- Reducing the volume of horizontal reflux through perforating vessels, increasing the outflow of blood in the deep veins of the leg.
- Improving the functioning of the calf muscle pump.
In general, compression stockings have a symptomatic effect and reduce the severity of chronic venous insufficiency. Underwear creates comfort in severe varicose veins. However, we cannot talk about a cure: the patient only improves the quality of life and reduces the likelihood of complications.
Compression garments do not remove varicose veins, do not restore the structure of the walls of peripheral vessels and cannot replace surgery. It only allows you to correct the existing signs of venous insufficiency, and this effect lasts only when wearing tights.
The result of wearing compression knit underwear:
- reduction of swelling of the lower leg and ankle joint, including in the evening and after a period of prolonged standing;
- decrease in the severity of pain, which is explained by a decrease in the degree of venous blood stagnation and improved 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 vein manipulations;
- reducing the feeling of discomfort in the legs;
- reducing the frequency and severity of leg muscle cramps.
Wearing a compression garment is recommended for varicose veins of any stage, postphlebothrombotic syndrome (PFTS). In some cases, it is also recommended for reticular varicose veins and telangiectasias (spider veins), lymphostasis of the lower limbs.
Particular importance is attached to compression therapy after operations and minimally invasive endovascular procedures (EVLO, laser obliteration, RFO). Wearing specialized knitwear 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 sclerosed vessel.
- Pronounced tissue changes due to chronic venous insufficiency (in the presence of trophic ulcers, lipodermatosclerosis).
- Phlebitis of superficial veins.
- Swelling, pain, tiredness in the legs.
- Tendency to be overweight.
Contraindications:
- clinically significant obliterating atherosclerosis of the lower extremities;
- endarteritis;
- purulent skin diseases of the lower extremities and microbial eczema;
- bedsores;
- open wound;
- diabetes mellitus with signs of endocrine polyneuropathy and impaired microcirculation in the distal limbs;
- acute cardiovascular failure.
The possibility of wearing compression stockings is determined by your doctor. A change in the patient's condition and the appearance of new symptoms requires re-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 phlebologist based on an examination and ultrasound scan of the veins of the lower extremities.
Make the right choice
When choosing compression, consider the following:
- the nature and speed of venous blood flow;
- the severity of pathological 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? Is it not possible to cope with the help of a consultant in an orthopedic salon?
No, self-analysis of symptoms is not enough for the correct choice of compression clothing: the doctor focuses not 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 concomitant 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 wearing
Risks of wearing compression class 3 in old age:
- Risk of stroke, heart attack.
- Severe cardiovascular failure.
Determining the tactics of treatment and choosing the class and type of compression hosiery is the doctor's prerogative. But the orthopedic salon consultant can handle the selection of the size and height of the product. He will also give detailed care instructions and teach you how to wear compression tights and socks correctly.
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 packaging. The standard is a guarantee of high quality, physiology and predictability.
High-quality therapeutic anti-varicose tricot is 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 and how much to wear
The sock is first turned over and rolled up, then rolled along the leg from bottom to top. This will ensure proper pressure distribution and prevent product deformation. There are also special fixtures that facilitate placement. They can also be purchased in orthopedic stores.
It is recommended to wear compression hosiery in the morning while you are still in bed: at this time 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, you keep your legs elevated for a few minutes 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, removed only in the evening 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 loading. The rules for wearing compression clothing are determined by your doctor.