From the Guidelines
Compression stockings are generally not recommended for patients with Peripheral Artery Disease (PAD) as they can further reduce blood flow to the legs and feet, potentially worsening symptoms and tissue damage. PAD involves narrowed arteries that reduce blood flow to the limbs, and adding external compression could compromise circulation even more 1. Instead, PAD patients should focus on treatments that improve blood flow, including:
- Regular walking exercise
- Smoking cessation
- Medications like antiplatelet agents (such as aspirin or clopidogrel)
- Statins to lower cholesterol
- Blood pressure control
If you have PAD and are considering compression therapy for another condition like venous insufficiency, it's essential to consult with a vascular specialist first. They can evaluate the severity of your arterial disease using measurements like the ankle-brachial index (ABI) and determine if any level of compression might be safe 1. In some cases where a patient has both venous and arterial disease, very light compression might be used under careful medical supervision, but this is the exception rather than the rule. The 2024 ESC guidelines for the management of peripheral arterial and aortic diseases recommend a comprehensive approach that addresses the entirety of arterial circulation, and emphasize the importance of lifestyle modifications, such as smoking cessation and regular physical activity, in reducing the risk of adverse cardiovascular events 1.
From the Research
Compression Stockings for PAD
- Compression stockings are not explicitly recommended for patients with Peripheral Artery Disease (PAD) in the study 2, which focuses on the medical management of PAD.
- However, a study 3 investigated the safety and effectiveness of a specific type of compression stocking designed for patients with both chronic venous insufficiency (CVI) and PAD, and found that it is safe for individuals with an ankle-brachial index ≥ 0.5.
- Another study 4 assessed the influence of compression therapy on microperfusion and its safety in patients with PAD or diabetes mellitus, and found that medical compression stockings are safe and feasible in patients with diabetes or PAD.
- A literature review 5 suggests that compression therapy, including compression stockings, can increase blood flow and aid in wound healing in patients with PAD, and may have a role in preventing oedema after peripheral artery bypass surgery.
- The study 6 focuses on the pharmacotherapy of PAD, but does not mention compression stockings as a treatment option.
Key Findings
- Compression stockings can be safe for patients with PAD, especially those with an ankle-brachial index ≥ 0.5 3.
- Medical compression stockings do not impair microperfusion parameters in patients with diabetes or PAD 4.
- Compression therapy, including compression stockings, may have a role in preventing oedema and aiding in wound healing in patients with PAD 5.