Compression Stockings Are Not Recommended in Your Situation
Given your peripheral hypoperfusion (stroke volume index of 23.69) and diastolic dysfunction, compression stockings are contraindicated and could worsen your arterial blood flow to the feet. Your concern about impeding arterial perfusion is medically valid and represents a critical safety consideration.
Why Compression Stockings Are Dangerous in Your Case
Peripheral Hypoperfusion Concerns
Your stroke volume index of 23.69 mL/m² indicates severely reduced cardiac output (normal is 35-65 mL/m²), meaning your tissues are already receiving inadequate blood flow 1, 2.
Compression therapy requires adequate arterial inflow to be safe. Before any compression is prescribed, an ankle-brachial index (ABI) must be measured to assess arterial circulation 1, 2.
If your ABI is <0.6, compression is absolutely contraindicated as it can cause tissue damage and requires arterial revascularization first 1, 3, 2.
Even with ABI 0.6-0.9, only reduced compression (20-30 mmHg) may be considered with extreme caution 1, 2.
Approximately 16% of patients with leg symptoms have unrecognized arterial disease, making ABI assessment critical before any compression therapy 2.
Diastolic Dysfunction Considerations
Your diastolic dysfunction means your heart already struggles with filling and maintaining adequate cardiac output 4.
Rapid fluid shifts from compression therapy could potentially exacerbate cardiac symptoms in patients with heart failure, making this a relative contraindication 1.
Congestive heart failure is listed as a relative contraindication for sequential compression devices due to concerns about fluid mobilization 1.
Additional Contraindications in Your Case
Severe leg edema itself is a contraindication for compression devices, as excessive swelling can be worsened by external compression 1.
Any skin breakdown or dermatitis from your peripheral hypoperfusion would be an absolute contraindication, as compression can worsen skin conditions and lead to further tissue damage 1.
What You Should Do Instead
Immediate Assessment Required
Demand an ankle-brachial index measurement before your interventional cardiology appointment to quantify your arterial circulation 1, 2.
Have your vascular status thoroughly evaluated given your peripheral hypoperfusion and toe numbness 2.
Alternative Approaches for Venous Thromboembolism Prevention
If DVT prophylaxis is needed while awaiting your procedure:
Intermittent pneumatic compression (IPC) devices are preferred over graduated compression stockings for patients with bleeding risk or compromised perfusion 5.
Early mobilization is critical - walking as little as 50 feet per day significantly decreases DVT risk without compromising arterial flow 5.
Pharmacological prophylaxis with low-molecular-weight heparin may be appropriate once your cardiac status is optimized and bleeding risk assessed 5.
Management of Your Underlying Conditions
Your iron deficiency should be aggressively treated, as it independently correlates with worsened diastolic function and reduced exercise capacity in patients with diastolic heart failure 6.
Your S1 radiculopathy causing toe numbness is a separate neurological issue that typically presents with symptoms in the lower buttock, dorso-lateral leg, and lateral foot 7, but does not change the contraindication to compression therapy.
Critical Pitfall to Avoid
Never apply compression therapy without first assessing arterial circulation through ABI measurement 1, 2. This is considered "the most dangerous error in compression therapy" 2. Your clinical intuition about compression potentially worsening arterial flow is correct - external compression in the setting of inadequate arterial inflow can lead to tissue ischemia, skin breakdown, and potentially gangrene 1.
The 2023 European trauma guidelines explicitly state they do not recommend graduated compression stockings for thromboprophylaxis 5, and recent large trials have shown compression stockings can cause harm in certain patient populations 5.