From the Guidelines
Compression stockings for venous insufficiency should be prescribed with graduated compression ranging from 20-30 mmHg for mild to moderate disease and 30-40 mmHg for severe disease or recurrent ulceration, as recommended by the most recent and highest quality study 1.
Key Considerations
- The severity of the disease should guide the prescription of compression stockings, with higher compression for more severe cases.
- Patients should wear knee-high or thigh-high stockings during waking hours and remove them at night.
- Proper sizing is essential and requires measurement of the ankle, calf, and thigh circumference, as well as limb length.
- Contraindications include severe peripheral arterial disease (ankle-brachial index <0.5), acute deep vein thrombosis, severe heart failure, and skin infections.
Application and Replacement
- Patients should be instructed to apply stockings in the morning before getting out of bed when edema is minimal, using application aids if needed.
- Stockings should be replaced every 3-6 months as they lose elasticity with regular washing and wear.
Therapeutic Benefits
- The therapeutic benefit of compression stockings comes from their ability to improve venous return by applying external pressure that counteracts hydrostatic forces, reduces edema, improves microcirculation, and prevents venous hypertension.
- Patient education about consistent daily use is crucial for symptom management and prevention of complications like venous ulcers, as supported by studies such as 1 and 1.
Important Notes
- While some studies, such as 1, 1, and 1, discuss the use of compression stockings in specific contexts, the most recent and highest quality study 1 provides the best guidance for prescribing compression stockings for venous insufficiency.
From the Research
Guidelines for Prescribing Compression Stockings
To prescribe compression stockings for patients with venous insufficiency, consider the following guidelines:
- The use of compression stockings is a standard, non-invasive treatment option for all venous and lymphatic diseases 2
- Compression stockings are recommended for patients with venous symptoms and for the prevention and treatment of venous oedema 2
- Robust evidence supports the use of compression stockings for the prevention and treatment of venous leg ulcers 2
- Compression stockings are also recommended for the maintenance phase of lymphoedema management 2
Indications for Compression Stockings
The following are indications for compression stockings:
- Chronic venous disorders: Compression stockings are recommended for patients with chronic venous disorders, including venous ulcers, oedema, and skin changes 2
- Acute deep vein thrombosis: Immediate compression is recommended to reduce pain and swelling in patients with acute deep vein thrombosis 2
- Post-thrombotic syndrome: Compression stockings are recommended to prevent post-thrombotic syndrome, despite conflicting results from recent studies 2
- Lymphoedema: Compression stockings are the most important intervention for the maintenance phase of lymphoedema management 2
Compression Stocking Characteristics
When prescribing compression stockings, consider the following characteristics:
- Compression level: The compression level should be tailored to the individual patient's needs, with higher compression levels recommended for more severe venous insufficiency 2
- Length: The length of the stocking should be determined by the location of the venous insufficiency, with knee-high stockings recommended for patients with venous insufficiency limited to the lower leg 3
- Material: The material of the stocking should be breathable and comfortable, with a variety of materials available, including cotton, nylon, and spandex 2
Evidence for Compression Stockings
The evidence for compression stockings is based on several studies, including:
- A meta-analysis of 51 publications, which found that compression stockings are effective in reducing the incidence of deep vein thrombosis and pulmonary embolism 2
- A randomized controlled trial, which found that compression stockings reduced the incidence of symptomless deep vein thrombosis in airline passengers 4
- A study of 139 patients undergoing lumbar laminectomies with instrumented fusions, which found that pneumatic compression stocking prophylaxis effectively reduced the incidence of deep vein thrombosis and pulmonary embolism 5