What type of compression stocking for chronic venous insufficiency?

Compression Stockings for Chronic Venous Insufficiency

For chronic venous insufficiency, compression stockings with 20-30 mmHg pressure should be used for mild to moderate disease, while 30-40 mmHg compression is recommended for severe venous disease. 1

Compression Pressure Guidelines

Pressure Recommendations Based on Disease Severity

• Mild to moderate CVI: 20-30 mmHg (minimum effective pressure) 1
• Severe CVI: 30-40 mmHg 1
• Venous leg ulcers (C6): 30-40 mmHg inelastic compression is superior to elastic bandaging for wound healing 2
• Patients with ankle-brachial indices 0.9-0.6: 20-30 mmHg is safe and effective 2
• Caution: Do not use compression therapy when ankle-brachial index <0.6 due to risk of arterial compromise 2, 1

Compression Type and Application

• Negative graduated compression (higher pressure at calf than ankle) provides improved ejection fraction in refluxing vessels compared to traditional graduated compression 2
• Inelastic compression (30-40 mmHg) is more effective than elastic bandaging for wound healing 2
• Velcro inelastic compression is as effective as 3- or 4-layer inelastic bandages 2

Special Considerations

Customization vs. Standard Stockings

• Customized compression stockings based on individual leg parameters show significantly improved quality of life scores compared to standard stockings 3
• Customized stockings provide more stable and enduring pressure, improving patient compliance (10.7 vs 9.5 hours daily wear time) 3

Skin Care and Comfort

• Compression stockings with integrated skin care better maintain skin moisture and reduce skin roughness, particularly beneficial for:
  • Patients with initially dry skin
  • Male patients
  • Patients with C3 disease (varicose veins with edema) 4

Compliance Challenges

• Only about 21% of patients use compression stockings daily, with 63% abandoning them after a trial period 5
• Common reasons for non-compliance include:
  • Binding/cutting off circulation (13%)
  • Heat discomfort (8%)
  • Difficulty applying without help (2%) 5

Donning Devices

• For elderly patients with severe CVI, donning devices significantly improve the ability to put on compression stockings:
  • Success rates increase from 60-70% to 88-90% with appropriate donning devices
  • Both foot slips (for open-toe stockings) and frames (for closed-toe stockings) are effective 6

Algorithm for Selecting Compression Stockings

1. Assess disease severity:

   • C1-C2 (telangiectasias, reticular/varicose veins): 20-30 mmHg
   • C3-C4 (edema, skin changes): 20-30 mmHg, consider 30-40 mmHg if symptoms persist
   • C5-C6 (healed/active ulcers): 30-40 mmHg inelastic compression 2, 1

2. Check arterial status:

   • Measure ankle-brachial index
   • If 0.9-0.6: Use 20-30 mmHg
   • If <0.6: Avoid compression therapy and refer for arterial evaluation 2, 1

3. Consider patient factors:

   • For patients with dry skin: Select stockings with integrated skin care 4
   • For elderly or patients with dexterity issues: Provide appropriate donning devices 6
   • For patients with difficulty tolerating standard stockings: Consider customized stockings 3

4. Ensure proper fit and application:

   • Focus compression at calf rather than ankle for improved hemodynamics 2
   • Provide education on proper application and wear time (8-12 hours daily) 1
   • Consider open-toe design if closed-toe is difficult to don 6

Compression therapy remains the mainstay of treatment for chronic venous insufficiency, with appropriate pressure selection and attention to patient-specific factors being critical for successful outcomes and compliance 7.