Compression stockings

Compression stockings

Compression stockings and socks are specialised hosiery items designed to increase blood circulation. Their main theraputic purpose is to provide graduated pressure on the lower leg and foot and, in some cases, the thigh, to alleviate circulatory problems such as edema, phlebitis and thrombosis. Unlike traditional dress or athletic stockings and socks, compression stockings use stronger elastics to create significant pressure on the legs, ankles and feet. Compression stockings are tightest at the ankles, gradually become less constrictive towards the knees and thighs. By compressing the surface veins, arteries and muscles, the circulating blood is forced through narrower circulatory channels. As a result, the arterial pressure is increased which causes more blood to return to the heart and less blood to pool in the feet. There are two types of compression stockings: Gradient and Anti-embolism.

Gradient compression stockings

These stockings are designed to remedy impaired "Musculovenous pump" performance caused by incompetent leg vein valves. They are woven in such a way that the compression level is highest around the ankle and lessens towards the top of the hose.
Doctors will typically recommend these stockings for those who are prone to blood clots, lower limb edema, and blood pooling in the legs and feet from prolonged periods of sitting or inactivity.
They are worn by those who are ambulatory in most cases, where they assist the calf muscles to perform their pumping action more efficiently to return blood to the heart. In some cases, they are worn by those at increased risk of circulatory problems, such as diabetics, whose legs are prone to excessive swelling. A common indicator for the prescription of such stockings is chronic peripheral venous insufficiency, caused by incompetent perforator veins. Low pressure compression stockings are available without prescription in most countries, and may be purchased at a pharmacy or medical supply store. Stockings with a higher pressure gradient, say, above 25-30mmHg, may require a prescription from a doctor.
There are several crucial cautionary steps that need to be taken before using compression stocking:

1. A patient's ABI (Ankle Brachial Index) must be >1.0 per leg to wear compression stockings, otherwise the stockings may obstruct the patient's arterial flow. The ABI indicates how unobstructed a patient's leg and arm arteries are. Any competent doctor or nurse can measure and calculate a patient's ABI.
   
2. It is crucial that compression stockings are properly sized. The compression should gradually reduce from the highest compression at the smallest part of the ankle, until a 70% reduction of pressure just below the knee.

Vascular doctors & nurses may use special pads to insure uniform higher pressure around the circumference of the ankle (to smooth out the irregular cross-sectional profile.)
Self-prescription is reasonably safe assuming that the compression gradient is 15-20 mmHg, the ABI (for both legs) is >1.0 and that the stockings fit correctly. "Firm" gradient stockings (20-30 mmHg and 30-40 mmHg) should generally be worn only on medical advice.
Although current research reports mixed results of compression socks on athletic performance ^{[1] [2]}, anecdotal evidence from athletes have reported to benefit from such stockings.

Anti-embolism compression stockings

These stockings are commonly referred to as T.E.D. hose, which is a registered brand name, although numerous others brands exist. They are used to support the venous and lymphatic drainage of the leg.^[3]
Like gradient compression stockings, anti-embolism stockings deliver a distributed amount of compression at the ankle and up the leg. This compression, when combined with the muscle pump effect of the calf, aids in circulating blood and lymph fluid through the legs (in non-ambulatory patients).

Compression wear has also been adopted by the sports science industry. Various garments have been developed to improve the efficiency of muscles by stabilising muscles and improving circulation/ lactic acid removal. Today, compression stockings are available in a wide range of opacities, colors, styles and sizes, making them virtually indistinguishable from regular hosiery or socks.

Indications for use

• Lipodermatosclerosis
• Chronic peripheral venous insufficiency
• Varicose veins
• Edema (swelling)
• Lymphedema
• Prevention ^[4][5] of Deep vein thrombosis (DVT) and the post-thrombotic syndrome (PTS) following DVT ^[6]
  • Clinical trial results published in 2009 failed to support the use of low compression, anti-embolism stockings to prevent DVT with stroke victims in a non-ambulatory, hospital setting.^[7]

Compression classes

Compression stockings are constructed using elastic fibers or rubber. These fibers help compress the limb, aiding in circulation.

Compression stockings are offered in different levels of compression. The unit of measure used to classify the pressure of the stockings is mmHg. They are often sold in one of the following pressure ranges:

Support - over-the-counter

• 10-15 mmHg
• 15-20 mmHg

With the advice or prescription of a physician or medical professional and proper sizing from a trained fitter:

• 20-30 mmHg
• 30-40 mmHg
• 40-50 mmHg
• 50+ mmHg

Compression levels used by some manufacturers for custom made, flat knitted products in the US and Europe:

• 18-21 mmHg
• 23-32 mmHg
• 34-46 mmHg
• >50 mmHg

Styles

• Knee-high (AD)
• Thigh-high (AG)
• Pantyhose (AT)

Commonly used terms for compression stockings

• Anti-embolism - Worn when non-ambulatory or post-surgical to help prevent pooling of blood in the legs that could lead to a venous thrombosis.

• Custom - uniquely made for a specific individual.

• Circular Knit - Seamless stockings that offer greater aesthetic appeal.

• Flat Knit - Stockings made with a seam that can be constructed in virtually any shape or size. Most often used in higher compression classes.

• Silver - Stockings constructed using special silver textile fibers. Silver offers natural anti-microbial protection.

• Lymphedema - compression stockings used to manage edema resulting from the onset of Lymphedema

• Support - mild compression stockings sold over-the-counter and without a physician's prescription

See also

• Compression sportswear
• Diabetic sock, which provides the opposite features
• Graduated Compression, which provides graduated compression, with applications in elite sport

References

1. ^ Laymon, Abigail S., Robert F. Chapman, Joel M. Stager, S. Lee Hong and Jeanne D. Johnston (2009). Lower Leg Compression Sleeves: Influence on Running Mechanics and Economy in Highly Trained Distance Runners. http://www.eurekalert.org/pub_releases/2010-06/iu-cca060110.php. 
2. ^ Kemmler W, von Stengel S, Köckritz C, Mayhew J, Wassermann A, Zapf J. (2009). "Effect of compression stockings on running performance in men runners". Journal of strength and conditioning research 23 (1): 101–5. doi:10.1519/JSC.0b013e31818eaef3. PMID 19057400. 
3. ^ Blättler W, Zimmet SE (2008). "Compression therapy in venous disease". Phlebology 23 (5): 203–205. doi:10.1258/phleb.2008.081004. PMID 18806201. 
4. ^ Amaragiri SV, Lees TA (2000). "Elastic compression stockings for prevention of deep vein thrombosis". Cochrane Database Syst Rev (1): CD001484. doi:10.1002/14651858.CD001484. PMID 10908501. 
5. ^ Clarke MJ, Hopewell S, Juszczak E, Eisinga A, Kjeldstrøm M (2006). "Compression stockings for preventing deep vein thrombosis in airline passengers". Cochrane Database Syst Rev (2): CD004002. doi:10.1002/14651858.CD004002.pub2. PMID 16625594. 
6. ^ Kokkos SK, Daskalopoullou SS, Daskolopoulos ME, Nicolaides AN, Geroulakos G (2006). "Review on the value of graduated elastic compression stockings after deep vein thrombosis". Thromb Haemost 96 (4): 441–5. PMID 17003920. 
7. ^ The CLOTS Trials Collaboration (multiple members as co-authors), Collaboration; Dennis, M; Sandercock, PA; Reid, J; Graham, C; Murray, G; Venables, G; Rudd, A et al. (2009). "Effectiveness of thigh-length graduated compression stockings to reduce the risk of deep vein thrombosis after stroke (CLOTS trial 1): a multicentre, randomised controlled trial". The Lancet 373 (9679): pp. 1958–1965. 6 June 2009. doi:10.1016/S0140-6736(09)60941-7. PMC 2692021. PMID 19477503. Archived from the original on 15 July 2009. http://www.webcitation.org/5iHfMPTwO. Retrieved 15 July 2009. 
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