Compression garments for varicose veins normalize blood flow, partially compensate for valve insufficiency and relieve pain and fatigue. It is used before and after varicose vein treatment to facilitate recovery. They are effective in conservative and minimally invasive treatment, eliminate the need for dressings and allow you to obtain a real result that corresponds to what was predicted.
In 2018, a large study was carried out on the effect of compression stockings 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 proven many times; Large studies have been carried out since 1985.
Currently, three types of compression underwear are produced - tights, stockings of different heights and knee-high stockings. The compression class is prescribed by a phlebologist during a face-to-face consultation.
Elastic compression of the lower extremities is nothing new in medicine. In Ancient Egypt, slaves and laborers practiced foot binding to increase endurance and performance, and legionnaires of the Roman Empire bound their feet during long walks. A similar method was used later, in the 17th to 19th centuries, by factory and plantation workers to speed up the recovery process and reduce swelling of the limbs after a hard day.
The method of dosed external compression was also used in medicine. The feasibility of its use in venous pathology was identified as early as the time of Hippocrates. Even so, a disease was described with the presence of bulging superficial vessels in the leg, swelling of the affected limb and a tendency to form ulcers. And for its treatment, pressure spiral bandages and bandages were widely used.
This technique has not been 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 used materials were cotton and knitted fabric and rubber straps.
The great advance was the emergence of an elastic bandage. It was patented in 1845 by British businessman and inventor Stephen Perry and later improved. Later, bandages with 3 degrees of elongation based on various materials began to be produced. They are still in use today. But the elastic bandage has a number of significant disadvantages.
Disadvantages of an elastic bandage:
- inconvenience;
- dependence of the result on careful adherence to the application technique;
- the likelihood of uneven distribution of compression;
- unaesthetic;
- risk of displacement of material loops.
In 1848, another product was patented, which prompted the emergence of a new direction in compression therapy. William Brown invented socks that allowed circular pressure to be applied to the lower limbs. Over time, advances in light industry made the production of pantyhose possible. And compression socks are currently recommended for use in various diseases that affect the veins of the lower limbs.
Classification of compression socks
Modern compression products are available in the form of tights, stockings of various heights, and knee-high stockings. But they are not divided just 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 adopted in Europe RAL-GZ 387. It is the most rigorous and regulates the nature of pressure distribution and its compliance with physiological patterns of venous flow, the quality and composition of materials used.
Compression garments are divided into 4 classes:
- Easy.Compression 18–21 mm Hg.
- Medium (moderate).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 tights and stockings. In fact, it is an incorrect substitute for the concept of "compression". This pseudomedical formulation is based on the fact that with an increase in the level of pressure applied, underwear becomes less elastic and denser to the touch. But using this term, and even more so trying to find a correspondence between the compression class and the density of ordinary socks (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 legs. The pressure it exerts is carefully calculated and rigorously dosed, which is guaranteed by the use of special materials with a special weave and yarn composition. According to the RAL-GZ 387 standard, tights and stockings cannot be transparent, translucent, colored or printed.
An important feature of compression stockings is the pressure gradient - its gradual decrease as it rises from the level of the ankle joint to the thigh. Furthermore, 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 foot, involving the ankle joint - this is where the great saphenous vein originates on the medial side and its main tributaries are located. Approximately at the level of transition from the belly of the calf muscle to the Achilles tendon, the pressure exerted by the stockings (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 limb and creates a blood flow close to physiological.
What changes when using compression clothing for varicose veins?
Compression socks exert dosed circular pressure, the level of which is determined by the compression class. The most affected are bulging varicose veins, which occur according to Laplace's law. All other superficial vessels are also pressed.
At a mechanical level:
- Reducing the diameter of venous vessels makes it possible to reduce the volume of deposited and stagnant blood.
- Pressing on varicose veins helps to reduce the effect of valve insufficiency and reduce return blood flow.
- Reducing the volume of horizontal reflux through the perforating vessels, increasing blood discharge into the deep veins of the leg.
- Improve the functioning of the calf muscle pump.
In general, compression stockings have a symptomatic effect and reduce the severity of chronic venous insufficiency. Lingerie creates comfort for severe varicose veins. However, we cannot talk about a cure: the patient only improves their quality of life and reduces the likelihood 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 the correction of existing signs of venous insufficiency, and this effect only lasts with the use of tights/stockings.
The result of using compression mesh underwear:
- reduction of swelling in the leg and ankle joint, including at night and after prolonged standing;
- reduction in pain intensity, which is 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;
- reducing the feeling of discomfort in the legs;
- reducing the frequency and severity of cramps in the leg muscles.
The use of compression garments is advisable for varicose veins of any stage, post-phlebothrombotic syndrome (PFTS). In some cases, it is also recommended for reticular varicose veins and telangiectasias (vascular veins), lymphostasis of the lower extremities.
Particular importance is given to compression therapy after operations and minimally invasive endovascular procedures (EVLO, laser obliteration, RFO). The use of specialized mesh 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 the superficial veins.
- Swelling, pain, fatigue in the legs.
- Tendency to be overweight.
Contraindications:
- clinically significant obliterating atherosclerosis of the lower extremities;
- 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 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 examination and ultrasound 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 vertical and horizontal pathological reflux;
- the presence of 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 underwear packaging contains a description of compression classes and their indications? Can't get by with the help of an orthopedic salon consultant?
No, self-analysis of symptoms is not sufficient for the correct selection of compression belts: the doctor does not just focus 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 concomitant somatic pathology: sometimes the use of high-class compression leads to a deterioration in the general condition, despite the correction of venous insufficiency.
Observe the compression level and usage mode
Risks of using compression class 3 in old age:
- Risk of stroke, heart attack.
- Severe cardiovascular failure.
Determining treatment tactics and selecting the class and type of compression stockings is the doctor's prerogative. But the consultant of an orthopedic salon can take care of selecting the size and height of the product. He will also give detailed care instructions and teach you how to wear compression stockings 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 to guarantee high quality, physiology and predictability.
High-quality therapeutic anti-varicose shirts are not sold in pharmacies. Products are presented in orthopedic salons.
Don't save money – don't buy fakes and products from unknown manufacturers. The compression will almost certainly be different from what is stated and the durability of the product will be low.
How to use and how much to use
The sock is first turned out and folded into a roll, and then rolled along the leg from bottom to top. This will ensure proper pressure distribution and prevent product deformation. There are also special devices that facilitate placement. They can also be purchased at orthopedic stores.
It is advisable to wear compression stockings in the morning while still in bed: this is when swelling in the legs is usually minimal, to achieve ideal compression of the veins. It is also recommended that before putting on pantyhose, keep your legs elevated for a few minutes and "work" your feet to further increase the flow of venous and lymphatic blood.
Anti-varicose compression products are sometimes used for a long time and are only removed at night, 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 use these stockings (tights) only during periods of static or dynamic loads. The rules for wearing compression garments are determined by your doctor.