Compression clothing for varicose veins normalizes blood flow, partially compensates for valvular insufficiency and relieves pain and fatigue. It is used both before the treatment of varicose veins and after to facilitate healing. They are effective in conservative and minimally invasive treatments, eliminate the need for dressings and allow you to achieve a real result that corresponds to the planned one.
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 significantly slows down, pain and swelling disappear. The positive effect of compression after surgical and minimally invasive treatment has been repeatedly proven; extensive studies have been carried out since 1985.
Currently, three types of compression underwear are produced: tights, stockings of different heights and knee-high socks. The compression course is prescribed by a phlebologist during an in-person consultation.
Elastic compression of the lower limbs is by no means new in medicine. In ancient Egypt, slaves and laborers practiced foot binding to increase their endurance and performance, and legionnaires in the Roman Empire bound their feet during long walks. A similar method was used later, in the 17th and 19th centuries, by factory and plantation workers to speed up the recovery process and reduce swelling in the limbs after a hard day.
The metered external compression method was also used in medicine. The feasibility of its use in venous pathology has been identified since the time of Hippocrates. Even then, a disease was described with the presence of bulging superficial vessels on the leg, swelling of the affected limb and a tendency to form ulcers. And for its treatment, bandages and spiral compression bandages were widely used.
This technique has not been forgotten. Gradually, new methods of bandaging the limbs against varicose veins and chronic venous insufficiency were developed. Elastic compression was also used as an independent method. The most commonly used materials were cotton, knitted fabric 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 was later improved. Subsequently, bandages of 3 degrees of elongation based on various materials began to be produced. They are still used today. But the elastic bandage has a number of significant disadvantages.
Disadvantages of an elastic bandage:
- inconvenience;
- dependence of the result on scrupulous compliance with the application technique;
- the likelihood of uneven distribution of compression;
- unsightly;
- risk of movement of the turns of material.
In 1848, another product was patented, which gave impetus to the emergence of a new direction in compression therapy. William Brown invented stockings allowing circular pressure to be applied distributed across the lower limbs. Over time, advances in light industry made it possible to produce tights. And currently, compression stockings are recommended for various diseases affecting the veins of the lower limbs.
Classification of support stockings
Modern compression products are available in the form of tights, stockings of different heights and knee-high socks. But they are not divided only by their 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 adopted in Europe, the strictest and regulates the nature of pressure distribution and its compliance with physiological patterns of venous flow, quality andcomposition of materials. used.
Compression garments are divided into 4 classes:
- Easy.Compression 18-21 mmHg.
- Medium (moderate).Compression 23-32 mm Hg.
- Strong.Compressions 34 to 46 mm Hg.
- Very strong.Compression 49 mm Hg.
The term "tightness" is sometimes used to describe compression tights and stockings. In fact, this is an incorrect replacement for the concept of "compression". This pseudo-medical formulation is based on the fact that with an increase in the level of pressure applied, the underwear actually becomes less stretchy and more dense 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 tights (measured in DEN), is illiterate and fundamentally wrong.
What is the difference between compression underwear and classic tightening tights?
Compression stockings do more than just compress the soft tissues of the legs. The pressure it exerts is carefully calculated and strictly dosed, which is ensured by the use of special materials with special thread weaving and composition. According to the RAL-GZ 387 standard, tights and stockings cannot be transparent, translucent, colored or patterned.
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. Moreover, these changes correspond to the physiological characteristics of the 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 - it is here that the great saphenous vein originates on the medial side and its main tributaries are located. Approximately at the transition from the calf muscle belly to the Achilles tendon, the pressure exerted by the stockings (tights) already represents approximately 65-70% of the supramalleolar pressure. At the knee, it's about 50%. And in the lower third of the thigh - 40% of the original.
The gradient acts in a measured manner on the superficial peripheral veins of the lower limb and creates a blood flow close to physiological.
What changes when wearing compression garments for varicose veins?
Compression tights exert a measured circular pressure, the level of which is determined by the compression class. The most affected are bulging varicose veins, which occurs in accordance with Laplace's law. All other superficial vessels are also squeezed.
At the mechanical level:
- Reducing the diameter of venous vessels helps reduce the volume of deposited and stagnant blood.
- Pressure on varicose veins helps reduce the effect of valve insufficiency and reduces the return flow of blood.
- Reduce the volume of horizontal reflux through the perforating vessels, thereby increasing the flow of blood into the deep veins of the leg.
- Improve calf muscle pump function.
In general, compression tights and stockings have a symptomatic effect and reduce the severity of chronic venous insufficiency. Lingerie creates comfort for severe varicose veins. However, we cannot speak of a cure: the patient only improves his quality of life and reduces the risk 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 helps correct existing signs of venous insufficiency, and this effect only lasts when wearing tights/stockings.
The result of wearing compression knitted underwear:
- reduction of swelling of the lower leg and ankle joint, including in the evening and after prolonged standing;
- reduction in pain intensity, which is explained by a reduction in the degree of stagnation of venous blood and improvement 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 rehabilitation period after surgical interventions and minimally invasive manipulations on the veins;
- reduce the feeling of discomfort in the legs;
- reducing the frequency and severity of cramps in the leg muscles.
Wearing compression garments is recommended for varicose veins of any stage, postphlebothrombotic syndrome (PFTS). In certain cases, it is also recommended in cases of reticular varicose veins and telangiectasias (spider veins), lymphostasis of the lower limbs.
Particular emphasis is placed on compression therapy after operations and minimally invasive endovascular procedures (EVLO, laser obliteration, RFO). Wearing specialized knitwear 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 superficial veins.
- Swelling, pain, fatigue in the legs.
- Tendency to be overweight.
Contraindications:
- clinically significant atherosclerosis obliterans of the lower extremities;
- endarteritis;
- pustular skin diseases of the lower limbs and microbial eczema;
- bedsores;
- open wound;
- diabetes mellitus with signs of endocrine polyneuropathy and impaired microcirculation in the distal extremities;
- acute cardiovascular failure.
The possibility of wearing 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 clothing cannot be chosen independently, it is prescribed exclusively by a phlebologist based on an examination and ultrasound of the veins of the lower extremities.
Make the right choice
When choosing compression, the following are taken into account:
- 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 ask themselves a completely logical question: why go to the doctor if the packaging of underwear contains a description of compression classes and their indications? Isn't it possible to get by with the help of a consultant in an orthopedic salon?
No, self-analysis of symptoms is not enough to correctly select compression garments: the doctor does not focus 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 concomitant somatic pathology: sometimes the use of a high compression class is fraught with a deterioration in general condition, despite the correction of venous insufficiency.
Observe compression level and wearing mode
Risks of wearing class 3 compression 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 prerogative of the doctor. But the consultant of an orthopedic salon can take care of the choice of size and height of the product. He will also give you detailed care instructions and teach you how to put on the compression tights and 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 a guarantee of high quality, physiology and predictability.
High-quality anti-varicose vein therapeutic jersey is not sold in pharmacies. The products are presented at orthopedic fairs.
Do not save money – do not buy fakes and products from unknown manufacturers. The compression will almost certainly be different from that declared and the durability of the product will be low.
How to wear and how much to wear
The stocking is first turned over and folded into a roll, then rolled out along the leg from bottom to top. This will ensure good pressure distribution and prevent product deformation. There are also special devices that make it easier to put on. They can also be purchased at orthopedic stores.
It is advisable to wear compression stockings in the morning in bed: this is when the swelling of the legs is generally minimal, in order to obtain optimal compression of the veins. It is also recommended, before putting on tights, to keep your legs elevated for a few minutes and "work" your feet to further increase the flow of venous blood and lymph.
Compressive anti-varicose veins products are sometimes worn for a prolonged period, removed only in the evening before going to bed. Such recommendations may be given, for example, for postphlebothrombotic syndrome (PFTS), thrombophlebitis and persistent edematous syndrome. In other cases (with initial varicose veins), it is enough to wear such stockings (tights) only during periods of static or dynamic loads. The rules for wearing compression garments are determined by your doctor.