In addition, if one chose to use compression stockings in this setting, treatment could be limited to 1 year in selected patients.Įlastic stockings are still used for indications not supported by RCTs, either empirically or based on intuitive choices. In turn, the latest IDEAL DVT trial, which did not include an untreated control group, showed that individualized duration of compression stocking use was as effective as 2.5 years of persistent use after acute DVT. Poorer adherence to treatment in the SOX trial was one possible reason for its negative result. Then, in 2016, the OCTAVIA study showed that 2 years of compression was more effective than 1 year. The SOX trial, in 2013, showed that elastic compression stockings (ECS) did not prevent post-thrombotic syndrome (PTS) after a first proximal DVT. Grade description of recommendations: 1A – strong recommendation, high-quality evidence, 1B – strong recommendation, moderate-quality evidence, 1C – strong recommendation, very low-quality evidence, 2A – weak recommendation, high-quality evidence, 2B – weak recommendation, moderate-quality evidence, 2C – weak recommendation, very low-quality evidence. ĬVD – chronic venous disease, MCS – medical compression stockings, VLU – venous leg ulcer. Based on available research and recommendations (last reviewed in 2017), MCSs are recommended in specific clinical situations ( Table 3). Elastic compression stockings improve the calf muscle pump function, reduce the amount of both venous reflux and venous volume, in turn normalising ambulatory venous pressure in limbs with CVI. Higher compression MCSs are indicated for patients with CVD and abnormal lymph drainage. By reducing the resting vein diameter, TPSs increase venous flow, prevent venous stasis and thrombosis. The TPSs offer compression of 15–18 mm Hg and they are indicated for use for bedridden or partly ambulant patients, as a part of oedema prevention. ![]() The commonly used GECSs can be divided into thromboprophylaxis stockings (TPS) and medical compression stockings (MCS). Currently PECSs are not available on the market. PECSs should be worn only during daytime activities and removed for resting and at night due to poor tolerance and the risk of increased oedema of distal, less compressed, leg segments. ![]() Unfortunately, just as GECSs, they are unable to restore normal EF, although their clinical effect on the EF is close to the one of inelastic bandages. As a result, PECSs are more effective in increasing the venous ejection fraction (EF). The pressure exerted at the C point should be about 50% higher than that at the B point. The PECSs provide a higher compression pressure over the C point. Graduated elastic compression stockings (GECS) provide a decreasing pressure profile from distal (B point) to proximal (degressive gradient), mimicking physiological pressure distribution ( Table 2). GECS are the standard compression therapy. These can be either graduated elastic compression stockings (GECS) with a decreasing compression profile or progressive elastic compression stockings (PECS) with a negative compression gradient. įurthermore, the manufacturers of compression hosiery are required to provide compression profiles. Pressure ranges should be assessed in vitro. The following recommendations are commonly supported: There is a lack of agreement on which classification should be universally applied. The two remaining ones include the CEN classification and the simplified ICC classification ( Table 1). ![]() ![]() The most common one is the RAL-GZG classification used for medical compression hosiery certification. Currently, there are several compression hosiery classification systems. However, considering significant differences in compression values between these classes in different countries, a pressure range (in mm Hg) exerted by the product at the ankle level assessed in vitro was proposed as a more uniform criterion. Historically, MCH were chosen based on a compression class. Both parameters are determined by the manufacturer. The selection criteria include the compression at the ankle level and material stiffness. Flat knit is the preferred manufacturing technique of products intended for patients with leg deformity. Both methods enable manufacturing of standard and non-standard hosiery products of different lengths: knee-length socks, stockings or tights. The circular knit textiles are thinner, more delicate and less stiff, with the final product of a cylindrical shape. The final product needs to be sewn together. Flat knit textiles are thicker and stiffer. Medical compression hosiery (MCH) is manufactured using elastic textiles.
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