Compression garments for varicose veins normalize blood flow, partially compensate for valve insufficiency and relieve pain and fatigue. It is used both before and after treatment of varicose veins to facilitate healing. They are effective in conservative and minimally invasive treatment, eliminate the need for clothing and allow you to get an actual result that corresponds to 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 you use 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 proven many times; major 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 face-to-face consultation.
Elastic compression of the lower extremities is not at all new in medicine. In Ancient Egypt, slaves and laborers practiced binding their feet to increase stamina and performance, and legionnaires of the Roman Empire bound their feet during long walks. A similar method was used later, in the 17th-19th centuries, by factory and plantation workers to speed up the recovery process and reduce limb swelling after a hard day.
The method of dosed external compression is also used in medicine. The feasibility of its use in venous pathology was identified since the time of Hippocrates. Even then, a disease was described with the presence of swollen superficial vessels in the legs, swelling of the affected limb and a tendency to form ulcers. And pressure bandages and spiral bandages were widely used for its treatment.
This technique was not forgotten. Gradually, new methods of limb bandaging for varicose veins and chronic venous insufficiency were developed. Elastic compression was also used as an independent method. The most commonly used materials were 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. Then, bandages with 3 degrees of elongation based on different materials began to be produced. They are still in use today. But elastic bandaging has a number of significant disadvantages.
Disadvantages of an elastic bandage:
- concern;
- dependence of the result on the careful observance of the application technique;
- the likelihood of uneven distribution of compression;
- unaesthetic;
- risk of displacement of material curves.
In 1848, another product was patented, which gave impetus to the emergence of a new direction in compression therapy. William Brown invented stockings that allowed circular pressure to be distributed to the lower limbs. Over time, advances in light industry made it possible to manufacture tights. And currently, it is compression stockings that are recommended for use in various diseases affecting the veins of the lower extremities.
Classification of compression stockings
Modern compression products are available in the form of tights, socks of various heights and knee socks. But they are separated not 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 standard RAL-GZ 387 approved in Europe. It is the strictest and regulates the nature of pressure distribution and its compliance with physiological patterns of venous outflow, quality and composition of 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.Too strong. Compression 49 mm Hg.
The term "compression" is sometimes used to describe compression tights and stockings. In fact, it is a wrong replacement of the concept of "compression". This pseudo-medical formulation is based on the fact that with an increase in the level of applied pressure, the underwear actually becomes less stretched and denser to the touch. But the use of this term, and even more so the attempt to seek 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 tights?
Compression socks do more than just compress the soft tissues of your feet. The pressure it exerts is carefully calculated and strictly dosed, which is ensured by the use of special materials with a special weaving of threads and composition. According to the RAL-GZ 387 standard, tights and socks cannot be transparent, translucent, colored or patterned.
An important characteristic of compression stockings is the pressure gradient - its gradual decrease as it rises from the level of the ankle joint to the thigh. Moreover, these changes correspond to the physiological characteristics of peripheral veins and the nature of blood flow.
The greatest pressure is in the supramalleolar region. Compression begins in the upper third of the leg, including the ankle joint - this is where the great saphenous vein begins on 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 the 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 acts in a dosed manner on the peripheral superficial veins of the lower limbs and creates a near-physiological blood flow.
What changes when you wear compression garments for varicose veins?
Compression tights exert dosed circumferential pressure, the level of which is determined by the compression class. The most affected are swollen varicose veins, which occur in accordance with Laplace's law. All other surface vessels are also pressed.
At the mechanical level:
- Reducing the diameter of venous vessels allows you to reduce the volume of stored and stagnant blood.
- Compression of varicose veins helps to reduce the effect of valvular insufficiency and reduce backflow of blood.
- Reducing the volume of horizontal reflux through the perforating vessels, increasing blood discharge in the deep veins of the leg.
- Improving the functioning of the calf muscle pump.
In general, tights and stockings with compression have a symptomatic effect and reduce the severity of chronic venous insufficiency. Underwear creates comfort for severe varicose veins. However, we cannot talk about a cure: the patient only improves the quality of life and reduces the possibility of complications.
Compression garments do not eliminate varicose veins, do not restore the structure of the walls of peripheral vessels and cannot replace surgery. It only allows you to correct existing signs of venous insufficiency and this effect only lasts when you wear tights/stockings.
The result of wearing compression knit underwear:
- reduction of swelling of the lower leg and ankle, 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 improvement of tissue trophism;
- reducing the risk of thrombosis;
- reducing the severity of trophic disorders and reducing the possibility of their occurrence;
- reduction of the duration of the rehabilitation period after surgical interventions and minimally invasive manipulations in the veins;
- reducing the feeling of discomfort in the legs;
- reducing the frequency and severity of leg muscle cramps.
Wearing compression garments is advisable 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 extremities.
Special importance is given to compression therapy after surgeries and minimally invasive endovascular procedures (EVLO, laser ablation, RFO). Wearing specialized knitwear significantly increases the effectiveness of such interventions.
Indications and contraindications
Indications:
- After sclerotherapy for better contact and subsequent fibrous "adhesion" of the walls of the sclerosed vessel.
- Marked tissue changes due to chronic venous insufficiency (in the presence of trophic ulcers, lipodermatosclerosis).
- Phlebitis of superficial veins.
- Swelling, pain, fatigue in the legs.
- Tendency to be overweight.
Contraindications:
- clinically significant obliterative atherosclerosis of the lower extremities;
- endarteritis;
- pustular diseases of the skin of the lower extremities and microbial eczema;
- bed sores;
- open wounds;
- diabetes mellitus with signs of endocrine polyneuropathy and impaired microcirculation 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 requires 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 exclusively by a phlebologist based on an examination and an ultrasound scan of the veins of the lower extremities.
Making the right choice
When choosing compression, consider the following:
- the nature and speed of venous blood flow;
- severity of vertical and horizontal pathological reflux;
- the presence of an obstruction to blood flow, 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 pass with the help of a consultant in an orthopedic salon?
No, self-analysis of symptoms is not enough for the right choice of compression garments: 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 accompanying somatic pathology: sometimes the use of a high class of compression is fraught with a worsening of the general condition, despite the correction of venous insufficiency.
Observe the level of compression and the manner of dressing
Risks of Class 3 Compression Garment in Old Age:
- Risk of stroke, heart attack.
- Severe cardiovascular failure.
Determination of treatment tactics and selection of the class and type of compression stockings is the prerogative of the doctor. But the consultant of an orthopedic salon can deal with the selection of the size and height of the product. He will also give you detailed care instructions and teach you how to put on compression stockings 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 flannel is not sold in pharmacies. 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 that stated, and the durability of the product will be low.
How to wear and how much to wear
The sock is first turned and folded into a roll, and then wrapped along the leg from the bottom up. This will ensure proper pressure distribution and prevent product deformation. There are also special devices that make it easier to install. They can also be purchased in orthopedic stores.
It is advisable to wear compression stockings in the morning while you are still in bed: precisely at this time the swelling of the legs is usually minimal, in order to achieve optimal compression of the veins. It is also recommended that before putting on tights, hold your legs up for a few minutes and "work" your legs to further increase venous blood and lymph flow.
Compression products against varicose veins are sometimes worn for a long time, removed only in the evening before going to bed. Such recommendations can be given, for example, for postphlebotrombotic 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 loads. The rules for wearing compression garments are determined by your doctor.