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 bandages, and allow you to obtain real results that match the predicted ones.
In 2018, a large study was conducted on the effect of compression stockings in the conservative treatment of varicose veins. It turns 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 surgery 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 various heights and knee socks. Compression classes are prescribed by a phlebologist during a face-to-face consultation.
Elastic compression on the bottom of the foot is nothing new in medicine. Back in Ancient Egypt, slaves and workers practiced binding their feet to improve endurance and performance, and legionnaires of the Roman Empire bound their feet when walking long distances. The same method was used later, in the 17th-19th centuries, by factory and farm workers to speed up the recovery process and reduce the swelling of limbs after a hard day.
The dosed external compression method is also used in medicine. The feasibility of its use in venous pathology was identified in the time of Hippocrates. Despite this, the disease is characterized by the presence of superficial bulging vessels on the legs, swelling of the affected limb and a tendency to form ulcers. And for its treatment, bandages and pressure spiral bandages are widely used.
This technique is not forgotten. Gradually, new methods of wrapping limbs for varicose veins and chronic venous insufficiency have been developed. Elastic compression is also used as an independent method. The most frequently used materials are cotton and knitted fabrics and rubber bands.
The breakthrough was the appearance of elastic bandages. It was patented in 1845 by British entrepreneur and inventor Stephen Perry and later improved. After that, bandages of 3 degrees of elongation based on various materials began to be produced. They are still used today. But elastic bandages have some significant disadvantages.
Disadvantages of elastic bandages:
- discomfort;
- dependence of results on careful adherence to application techniques;
- possibility of uneven compression distribution;
- unaesthetic;
- the risk of displacement of material windings.
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 distributed circular pressure to be applied to the lower limbs. Over time, advances in light industry made it possible to produce tight clothing. And currently, it is a compression sock that is recommended for use in various diseases that affect the veins of the lower leg.
Classification of compression socks
Modern compression products are available in the form of tights, socks of various heights and knee socks. But they are divided not only by appearance. They are also divided into classes according to the level 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 adopted in Europe. It is the most strict and controls the nature of the pressure distribution and its compliance with the physiological pattern of venous outflow, the quality and composition of the material. used.
Compression garments are divided into 4 classes:
Easy. Compression 18–21 mm Hg.Moderate (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 tights and compression stockings. In fact, it is a false substitute for the concept of "compression". This pseudo-medical formulation is based on the fact that with increased levels of applied pressure, the underwear actually becomes less stretchy and firmer to the touch. But using this term, and even more so trying to find a match between the compression class and the density of regular 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 the foot. The pressure it exerts is carefully calculated and strictly dosed, which is ensured by the use of special materials with woven threads and a special composition. According to the RAL-GZ 387 standard, tights and stockings cannot be transparent, translucent, colored or patterned.
An important feature of compression socks is the pressure gradient - a 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 blood flow properties.
The greatest pressure is in the supramalleolar region. Compression begins in the upper third of the leg, involving the ankle joint - this is where the great saphenous vein originates from the medial side and its main tributary is located. Approximately at the level of the transition of the belly of the calf muscle to the Achilles tendon, the pressure exerted by (tight) stockings is already about 65-70% of the supramalleolar pressure. In the knee it is about 50%. And in the third part of the lower part of the thigh - 40% of the original.
The gradient acts in a dose-dependent manner on the peripheral superficial veins of the lower limbs and creates blood flow close to physiological.
What changes when wearing compression garments for varicose veins?
Compression tights provide dosed circular pressure, the level of which is determined by the compression class. The most affected are the bulging varicose veins, which occur according to Laplace's law. All other shallow vessels are also pressed.
At the mechanical level:
- Reducing the diameter of the venous vessels allows you to reduce the amount of deposited and stagnant blood.
- Compressing varicose veins helps reduce the effects of valve insufficiency and reduce blood backflow.
- Reduces the amount of horizontal reflux through the perforated channel, increasing the release of blood into the veins in the legs.
- Improves calf muscle pump function.
In general, compression tights and stockings have a symptomatic effect and reduce the severity of chronic venous insufficiency. Undergarments create 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 peripheral vessel walls and cannot replace surgery. It only allows you to correct existing signs of venous insufficiency, and this effect only lasts while wearing tights/stockings.
Results of wearing compression knit underwear:
- reduction of swelling of the lower legs and ankle joints, including in the evening and after prolonged periods of standing;
- reduction in the severity of pain, which is explained by a decrease in the level of venous blood stagnation and an increase in tissue trophism;
- reduce the risk of thrombosis;
- reduce the severity of trophic disorders and reduce the likelihood of their occurrence;
- reduce the duration of the recovery period after surgical intervention and minimally invasive manipulation of veins;
- reduce discomfort in the legs;
- reduce the frequency and severity of leg muscle cramps.
Wearing compression garments is advised for varicose veins of any stage, postphlebothrombotic syndrome (PFTS). In some cases, it is also recommended for reticular varicose veins and telangiectasia (spider veins), lymphostasis of the lower legs.
Special importance is attached to postoperative compression therapy and minimally invasive endovascular procedures (EVLO, laser ablation, RFO). Wearing special knitwear significantly increases the effectiveness of such interventions.
Indications and contraindications
Guidance:
- After sclerotherapy for better contact and subsequent "adhesion" of the fibrous walls of the sclerosed vessels.
- Significant tissue changes due to chronic venous insufficiency (in the presence of trophic ulcers, lipodermatosclerosis).
- Phlebitis in superficial veins.
- Swelling, pain, fatigue in the legs.
- Tendency to be overweight.
Contraindications:
- clinically obliterating atherosclerosis of the lower leg;
- endarteritis;
- pustular skin disease on the lower part of the legs and microbial eczema;
- bed sores;
- open wounds;
- diabetes mellitus with signs of endocrine polyneuropathy and impaired microcirculation in the distal end;
- acute cardiovascular failure.
The ability to wear compression stockings is determined by your doctor. Changes in the patient's condition and the appearance of new symptoms require a second consultation with a phlebologist to determine further treatment tactics.
How to choose a compression product?
Compression garments cannot be chosen independently; it is prescribed exclusively by a phlebologist based on an examination and ultrasound scan of the lower leg veins.
Make the right choice
When choosing compression, the following are taken into account:
- the nature and speed of venous blood flow;
- 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 the compression class and indications for them? Is it not possible to survive with the help of a consultant in an orthopedic salon?
No, self-analysis of symptoms is not enough for the correct selection of compression garments: doctors focus not only on the degree of venous insufficiency and clinical symptoms. Other factors are also important. And the determining parameter is often age and the presence of concomitant somatic pathology: sometimes the use of a high class of compression is fraught with deterioration in the general condition, despite the correction of venous insufficiency.
Pay attention to the level of compression and mode of application
Risks of wearing compression class 3 in old age:
- Risk of stroke, heart attack.
- Severe cardiovascular failure.
Determining treatment tactics and choosing the class and type of compression stockings is the doctor's prerogative. But orthopedic salon consultants can handle the selection of product size and height. He will also provide detailed care instructions and teach you how to properly wear compression tights and stockings.
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 jersey is not sold in pharmacies. Products are presented in orthopedic salons.
Do not save money - do not buy fakes and products from unknown manufacturers. Compression will almost certainly be different than declared, and product durability will be low.
How to wear and how much to wear
The socks are first removed and folded into a roll, and then rolled along the legs from bottom to top. This will ensure proper pressure distribution and avoid product deformation. There are also special devices that make it easier to use. They can also be purchased at orthopedic stores.
It is advisable to wear compression socks in the morning while still in bed: this is when the swelling of the legs is usually minimal, so that optimal compression of the veins can be achieved. It is also recommended that before putting on tights, hold your legs elevated for a few minutes and "work" your legs to further increase the outflow 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 early varicose veins), it is enough to wear such stockings (tights) only for periods of static or dynamic loading. The rules for wearing compression garments are determined by your doctor.