Compression garments for varicose veins help normalize blood flow, partially compensate for valve insufficiency, relieve pain and fatigue. It is used both before treating varicose veins and after to facilitate recovery. They are effective in conservative and minimally invasive treatment, eliminating the need for bandages and allowing you to achieve actual results that correspond to the predicted results.
In 2018, a large study was conducted on the effects of compression stockings in the conservative treatment of varicose veins. It turned out that when the first layer of compression was used, the progression of the disease slowed down significantly, pain and swelling disappeared. The positive effect of postoperative compression and minimally invasive treatment has been proven repeatedly, large studies have been conducted since 1985.
Currently, three types of compression underwear are produced - tights, socks of different heights and knee socks. The compression layer is prescribed by the phlebologist during a face-to-face consultation.
Elastic compression of the lower extremities is not new in medicine. Back in ancient Egypt, slaves and workers practiced binding their feet to increase endurance and performance, and legionaries of the Roman Empire bound their feet while hiking. A similar method was used by factory and plantation workers later, in the 17th-19th centuries to speed up the recovery process and reduce swelling of the limbs after a hard day.
The method of dosed external compression is also used in medicine. The feasibility of its use in venous pathology has been established since the time of Hippocrates. Even then, a disease was described with the presence of swollen superficial blood vessels in the legs, swelling of the affected limb and a tendency to form ulcers. And for treatment, pressure spiral bandages and bandages have been widely used.
This technique is not forgotten. Gradually, new methods of bandaging limbs for varicose veins and chronic venous insufficiency were developed. Elastic compression is also used as an independent method. The most commonly used materials are cotton fabric, knitted fabric and rubber bands.
The breakthrough was the appearance of elastic bandages. It was patented in 1845 by British businessman and inventor Stephen Perry and was later improved. Later, 3-degree elongation tapes based on various materials began to be produced. They are still in use today. But elastic bandages have some significant disadvantages.
Disadvantages of elastic bandages:
- inconvenience;
- dependence of results on careful adherence to application technique;
- possibility of uneven distribution of compression;
- lack of aesthetics;
- risk of displacement of material rotations.
In 1848, another product was patented, giving impetus to the emergence of a new direction in compression therapy. William Brown invented socks that allowed for circular distribution of pressure on the lower limbs. Over time, advances in light industry made it possible to produce tights. And now, compression hosiery is recommended for various diseases affecting the veins of the lower limbs.
Classification of compression knitwear
Modern compression products are available in the form of tights, socks of different heights and knee socks. But they aren't just divided 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 applied in Europe. This is the most stringent standard and regulates the properties of pressure distribution as well as its compliance with the physiological patterns of venous outflow, the quality and composition of the materials used.
Compression garments are divided into 4 types:
- Easy.Compression 18–21 mm Hg.
- Average (average).Compression 23–32 mm Hg.
- Strong.Compression 34–46 mm Hg.
- Very strong.Compression 49 mm Hg.
The term "tightness" is sometimes used to describe compression tights and stockings. Actually, it's an incorrect replacement for the concept of "compression". This pseudo-medical formula is based on the fact that as pressure levels increase, underwear actually becomes less elastic and denser to the touch. But the use of this term, and even more so, the attempt to find a correspondence between the compression layer and the density of ordinary tights (measured in DEN) is illiterate and fundamentally wrong.
What is the difference between compression underwear and regular tights?
Compression socks don't just compress the soft tissues of the legs. The pressure it creates is carefully calculated and strictly dosed, this is ensured by using special materials with special composition and textile fibers. According to standard RAL-GZ 387, tights and stockings must not be transparent, opaque, colored or patterned.
An important characteristic of compression hosiery is the pressure gradient - the pressure gradient gradually decreases as it increases from the level of the ankle joint to the thigh. Furthermore, these changes correspond to the physiological characteristics of peripheral veins and the properties of blood flow.
The greatest pressure is in the supragranular region. Compression begins in the upper part of the foot, involving the ankle joint - this is where the great saphenous vein originates from the medial side and its main branches are located. At the level of the transition of the calf muscle belly to the Achilles tendon, the pressure caused by the stockings (tights) is already about 65–70% of the ultrasonic pressure. In the knee it is about 50%. And in the lower part of the thigh - 40% of the original.
The gradient quantitatively acts on the peripheral superficial veins of the lower extremities and produces a blood flow close to physiological.
What changes when wearing compression garments for varicose veins?
Compression tights produce quantitative circular pressure, the level of which is determined by the level of compression. Most affected are varicose veins, which occur according to Laplace's law. All other surface vessels are also laminated.
At the mechanical level:
- Reducing the diameter of veins allows you to reduce the amount of stagnant and stagnant blood.
- Compression of varicose veins helps reduce the effects of valve insufficiency and reduces blood flow.
- Reduces the volume of reflux across vascular perforations, increasing blood flow into the deep veins of the legs.
- Improves the function of the calf muscle pump.
In general, compression stockings and compression stockings are effective in treating the symptoms and reducing the severity of chronic venous insufficiency. Underwear creates a comfortable feeling for people with severe varicose veins. However, we cannot talk about curing the disease: patients only improve their quality of life and reduce the likelihood 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 varicose veins and this effect only lasts while wearing tights/stockings.
Results of wearing compression knitted underwear:
- reduces swelling in the lower legs and ankle joints, including in the evening and after long periods of standing;
- reduces the severity of pain, which is explained by a decrease in the degree of venous blood stagnation and improvement in the nutritional status of tissues;
- reduces the risk of thrombosis;
- reduces the severity of nutritional disorders and reduces the likelihood of their occurrence;
- reduces recovery time after surgical intervention and minimally invasive manipulations on veins;
- Reduces discomfort in the legs;
- Reduces the frequency and severity of leg muscle cramps.
Compression garments are recommended for varicose veins at any stage, post-thrombotic syndrome (PFTS). In some cases, it is also recommended for reticular varicose veins and telangiectasias (spider veins), for the treatment of lymphoma of the lower extremities.
Of particular importance are postoperative compression therapy and minimally invasive endovascular procedures (EVLO, laser ablation, RFO). Wearing specialized hosiery significantly increases the effectiveness of such interventions.
Indications and contraindications
Point:
- After sclerotherapy for better exposure and subsequent "gluing" of the fibers to the sclerotic vessel wall.
- Marked tissue changes due to chronic venous insufficiency (in the presence of trophic ulcers, liposclerosis).
- Superficial phlebitis.
- Swollen, painful, tired legs.
- Tendency to be overweight.
Contraindications:
- Eliminate clinically significant atherosclerosis in the lower extremities;
- Endometritis;
- pustular dermatosis of the lower extremities and bacterial eczema;
- sore;
- open wound;
- diabetes mellitus with signs of endocrine polyneuropathy and impaired microcirculation in the distal limbs;
- acute heart failure.
The ability to wear compression stockings is determined by the doctor. A change in the patient's condition and the appearance of new symptoms require a second consultation with the venous surgeon to determine further treatment tactics.
How to choose a compression product?
Compression garments cannot be chosen independently, they are prescribed by a phlebologist based on 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 reflux pathology;
- the presence of obstruction of blood outflow, the most common cause of which is thrombosis.
Many patients have a completely reasonable question: why go to the doctor if the package of underwear has a description of compression layers and indications for them? Can't get by with the help of a consultant in an orthopedic salon?
No, analyzing the symptoms yourself is not enough to choose the right type of compression garment: the doctor does not focus only 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 physical pathologies: sometimes the use of high compression can lead to a deterioration of the general condition, despite correction of impairment. vein.
Observe the compression level and wear mode
Risks of wearing compression layer 3 in old age:
- Risk of stroke and heart attack.
- Severe cardiovascular failure.
Determining treatment tactics and choosing the type and type of compression hosiery is the doctor's prerogative. But the consultant of the orthopedic salon can handle the selection of the size and height of the product. He will also provide detailed care instructions and teach you how to properly wear compression tights and stockings.
Preference should be given to brands that have the manufacturer's instructions to the RAL-GZ 387 standard. This will be indicated by the corresponding symbol on the packaging. This standard is a guarantee of quality, physiology and high predictability.
High-quality therapeutic anti-varicose bras are not sold in pharmacies. The products are presented in orthopedic salons.
Don't save money – don't buy fakes and products from unknown manufacturers. The compression level will almost certainly be different from the declared compression level and the durability of the product will be low.
How to wear and how much to wear
First, the sock is turned out and folded into a roll, then rolled along the leg from bottom to top. This will ensure proper pressure distribution and prevent deformation of the product. There are also special devices that make it easier to put on. They can also be purchased at orthopedic stores.
Compression stockings should be worn in the morning while still in bed: at this time swelling in the legs is usually minimal so that optimal venous compression can be achieved. You should also elevate your legs for a few minutes and "work" them to further increase venous blood and lymph flow.
Anti-varicose compression products are sometimes worn for long periods of time, removed only at night before going to bed. Such recommendations may be given, for example, for post-thrombotic syndrome (PFTS), thrombophlebitis and refractory edema syndrome. In other cases (with initial varicose veins), it is necessary to wear such stockings (tights) only during periods of static or dynamic loading. Regulations for wearing compression garments will be determined by your doctor.