From the Guidelines
Compression stockings are not recommended for patients with lower extremity peripheral bypass in several specific situations, including severe peripheral arterial disease (PAD) with an ankle-brachial index (ABI) less than 0.5, as they can further reduce blood flow to the limb and potentially compromise the bypass graft, as suggested by the most recent guidelines 1.
Key Contraindications
- Severe peripheral arterial disease (PAD) with an ABI less than 0.5
- Acute deep vein thrombosis, as suggested by the American Society of Hematology 2020 guidelines 1
- Severe heart failure
- Active skin infections in the affected limb
- Recent bypass surgery without complete wound healing
- Peripheral neuropathy with diminished sensation
Rationale
The rationale behind these contraindications is that compression stockings work by applying external pressure to the legs, which can potentially impair arterial circulation in already compromised vessels, leading to tissue ischemia and potentially graft failure.
Recommendations
Before prescribing compression therapy, clinicians should perform a thorough vascular assessment including ABI measurements and evaluate the patient's overall cardiovascular status, as recommended by the 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS guideline for the management of lower extremity peripheral artery disease 1.
Important Considerations
- The use of compression stockings may help reduce edema and pain associated with acute DVT in selected patients, but this should be weighed against the potential risks, as noted in the American Society of Hematology 2020 guidelines 1.
- The executive summary of the Chest guideline and expert panel report also suggests against using compression stockings routinely to prevent post-thrombotic syndrome (PTS) in patients with acute DVT of the leg 1.
From the Research
Compression Stockings in Lower Extremity Peripheral Bypass
- Compression stockings are not recommended for patients with severe peripheral artery disease (PAD) without revascularisation, as they may worsen the condition 2.
- However, compression stockings may be beneficial in preventing oedema after peripheral artery bypass surgery, thereby diminishing pain and reducing the risk of surgical wound dehiscence 2.
- Patients with an ankle-brachial index < 0.5 should not use compression stockings, as they may cause further arterial flow obstruction 3.
- Compression stockings are safe for individuals with an ankle-brachial index ≥ 0.5, and may even be beneficial in patients with advanced PAD, as they do not lead to a deterioration of microperfusion parameters 4.
Specific Conditions
- In patients with chronic venous insufficiency (CVI) and PAD, compression stockings can be safe and effective, as they improve CVI symptoms and do not cause skin damage 3.
- In patients with venous and lymphatic disorders, medical compression stockings are a standard treatment option, and are recommended for the prevention and treatment of venous oedema, venous leg ulcers, and lymphoedema 5.
- However, the use of compression stockings in patients with acute deep vein thrombosis is recommended to reduce pain and swelling, but their role in preventing post-thrombotic syndrome is still unclear 5.
Important Considerations
- The use of compression stockings in patients with PAD and diabetes is still a topic of debate, and further studies are needed to determine their safety and efficacy in these patients 4.
- Compression stockings may not preserve arterial macrovascular and microvascular responses to prolonged sitting, and further study is warranted to determine their additive benefits when combined with sitting interruption strategies 6.