Compression clothing for varicose veins normalizes blood flow, partially compensates for valve failure and relieves pain and fatigue. It is used both before the treatment of varicose veins and to facilitate recovery. They are effective in conservative and minimally invasive treatment, eliminate the need for bandages and allow you to get a real result that corresponds to the predicted one.
In 2018, a large study was conducted on the effect of compression garments in the conservative treatment of varicose veins. It was found that when using the first class of compression, the course of the disease slows down significantly, pain and swelling disappear. The positive effect of compression after surgical and minimally invasive treatment has been repeatedly proven, large studies have been conducted since 1985.
Currently, three types of compression underwear are produced - pantyhose, socks of different heights and knee socks. The compression class is prescribed by a phlebologist during a face-to-face consultation.
Elastic compression of the lower limbs is not at all new in medicine. Slaves and laborers in ancient Egypt performed foot binding to increase stamina and work capacity, and legionnaires in the Roman Empire bound their feet during long walks. A similar method was later used by factory and plantation workers in the 17th and 19th centuries to speed up the recovery process and reduce swelling in the limbs after a hard day's work.
The method of dosed external compression was also used in medicine. The expediency of its use in the pathology of veins was revealed as early as the time of Hippocrates. Even then, the disease was described by the presence of bulging superficial vessels on the leg, swelling of the affected limb and a tendency to ulceration. And bandages and pressure coils were widely used to treat it.
This technique was not forgotten. Gradually, new methods of washing limbs in varicose veins and chronic venous insufficiency were developed. Elastic compression was also used as an independent method. The most commonly used materials were cotton and woven fabric and rubber bands.
The breakthrough was the appearance of an elastic bandage. It was patented in 1845 by British entrepreneur and inventor Stephen Perry and has since been improved upon. Subsequently, the production of bandages with 3 degrees of elasticity based on different materials was started. They are still used today. But the elastic bandage has many significant disadvantages.
Disadvantages of an elastic bandage:
- discomfort;
- Dependence of the result on the careful observance of the application technique;
- probability of uneven distribution of compression;
- unaesthetic;
- Risk of material turnover displacement.
In 1848, another product was patented, which gave impetus to the emergence of a new direction in compression therapy. William Brown invented stockings that allowed distributed circular pressure to be applied to the lower limbs. Over time, advances in light industry made it possible to manufacture pantyhose. And currently, it is the use of compression clothing that is recommended for various diseases affecting the veins of the lower extremities.
Classification of compression garments
Modern compression products are available in the form of tights, socks of various heights and knee socks. But they are divided not only in appearance. They are also divided into classes according to their degree of compression. It is measured in millimeters of mercury.
The classification of the compression products used is based on the German standard RAL-GZ 387 adopted in Europe. It is the strictest and regulates the nature of the pressure distribution and its compliance with the physiological models of venous flow, the quality and composition of the materials. used.
Compression clothing is divided into 4 classes:
Easy. Compression 18–21 mm Hg.average (moderate). Compression 23–32 mm Hg.strong. Compression 34–46 mm Hg.Very strong. Compression 49 mm Hg.
The term "tightness" is sometimes used to describe compression tights and stockings. In fact, it is a misnomer for the concept of "compression". This pseudo-medical wording is based on the fact that as the level of pressure increases, the underwear actually becomes less elastic and firmer to the touch. But the use of this term andEspecially since the search for a correspondence between the compression class and the density of ordinary tights (measured in DEN) is illiterate and fundamentally wrong.
What is the difference between compression underwear and regular tights?
Compression fabric does more than just compress the soft tissue of your legs. The pressure on it is carefully calculated and strictly dosed, which is ensured by the use of special materials and special weaving of threads and composition. According to the RAL-GZ 387 standard, tights and socks cannot be transparent, transparent, colored or patterned.
An important feature of compression clothing is the pressure gradient - its gradual decrease from the level of the ankle joint to the thigh. Moreover, these changes correspond to the physiological characteristics of peripheral veins and the nature of blood flow.
The greatest pressure is in the supramalleolar region. Compression begins in the upper third of the leg, which includes the ankle joint - this is where the large saphenous vein originates from the medial side and its main tributaries are located. Approximately at the level of the transition of the calf muscle to the Achilles tendon, the pressure exerted by the socks (pantyhose) is already about 65-70% of the upper pressure. At the knee it is about 50%. And in the lower third of the thigh - 40% of the original.
The gradient acts in a dosed manner on the peripheral superficial veins of the lower limb and creates a blood flow close to physiological.
What changes when wearing compression garments for varicose veins?
Compression tights apply a dosed circular pressure, the level of which is determined by the compression class. Varicose veins are the most affected, which occurs according to Laplace's law. All other surface vessels are also pressed.
At the mechanical level:
- Reducing the diameter of venous vessels allows you to reduce the volume of deposited and stagnant blood.
- Compression of varicose veins helps to reduce the effect of valvular insufficiency and reduce the return flow of blood.
- Reducing the volume of horizontal reflux through the perforated vessels, increasing blood flow in the deep veins of the leg.
- Improving calf muscle pump function.
In general, compression tights and stockings have a symptomatic effect and reduce the severity of chronic venous insufficiency. Linen provides comfort for severe varicose veins. However, we cannot talk about a cure: the patient only improves the quality of life and reduces the likelihood of complications.
Compression garments do not eliminate varicose veins, do not restore the structure of the walls of peripheral blood vessels, and cannot replace surgery. It only allows you to correct the existing signs of venous insufficiency and this effect only lasts while wearing tights/socks.
Result of wearing compression knit underwear:
- reduction of swelling of the lower leg and ankle joint, including in the evening and after standing for a long time;
- decrease in the severity of pain, which is explained by the decrease in the degree of stagnation of venous blood and the improvement of tissue trophism;
- reducing the risk of thrombosis;
- reducing the severity of trophic disorders and reducing the probability of their occurrence;
- Reducing the length of the rehabilitation period after surgical interventions and minimally invasive manipulations on veins;
- reduction of the feeling of discomfort in the legs;
- Reducing the frequency and severity of cramps in the leg muscles.
Compression garments are appropriate for any stage of post-phlebothrombic syndrome (PFTS) varicose veins. In some cases, it is also recommended for reticular varicose veins and telangiectasia (spider veins), lymphostasis of the lower limbs.
Special importance is given to compression therapy after operations and minimally invasive endovascular procedures (EVLO, laser obliteration, RFO). Wearing specialized knitted clothing significantly increases the effectiveness of such interventions.
Indications and contraindications
Indications:
- For better contact after sclerotherapy and subsequent fibrous "gluing" of the walls of sclerosed vessels.
- Pronounced tissue changes due to chronic venous insufficiency (in the presence of trophic ulcers, lipodermatosclerosis).
- Phlebitis of superficial veins.
- Swelling, pain, fatigue in the legs.
- Tendency to be overweight.
Contraindications:
- clinically significant obstructive atherosclerosis of the lower extremities;
- endarteritis;
- pustular skin diseases of the lower extremities and microbial eczema;
- beds
- open wounds;
- diabetes mellitus with signs of endocrine polyneuropathy and microcirculation disorders in the distal limbs;
- Acute cardiovascular failure.
The ability to wear compression stockings will be determined by your doctor. A change in the patient's condition and the appearance of new symptoms require a second consultation with a phlebologist to determine the tactics of further treatment.
How to choose a compression product?
Compression clothes cannot be chosen independently, they are prescribed exclusively by a phlebologist on the basis of an examination of the veins of the lower extremities and an ultrasound scan.
make the right choice
When choosing compression, the following is taken into account:
- the nature and speed of venous blood flow;
- severity of pathological vertical and horizontal reflux;
- The presence of a blockage of blood flow, which is most often caused by thrombosis.
Many patients have a completely logical question: why do you go to the doctor, if the package of underwear contains a description of compression classes and instructions for them? Can't you go to the orthopedic salon with the help of a consultant?
No, self-analysis of symptoms is not enough for the correct selection of compression garments: the doctor focuses not only on the degree of venous insufficiency and clinical symptoms. Other factors are also important. And the determining parameters are often age and the presence of accompanying somatic pathology: sometimes the use of a high class of compression is fraught with deterioration of the general condition, despite the correction of venous insufficiency.
Observe the compression level and bearing mode
Risks of wearing Class 3 compression in old age:
- Risk of stroke, heart attack.
- Severe cardiovascular failure.
Determining the treatment tactics and selecting the class and type of compression garments is the doctor's prerogative. But the orthopedic salon consultant can handle the selection of product size and height. He will also give you detailed care instructions and teach you how to put on compression tights and stockings.
Preference should be given to brands whose manufacturers are guided by the RAL-GZ 387 standard. This will be indicated on the package with the appropriate icon. The standard is a guarantee of high quality, physiology and predictability.
High-quality therapeutic anti-varicose t-shirt is not sold in pharmacies. Products are presented in orthopedic salons.
Do not save money - do not buy fake and unknown manufacturers' products. Shrinkage will almost certainly differ from the declared one, and the durability of the product will be lower.
How to wear and how much to wear
The sock is first rolled out and rolled up, and then it is rolled along the leg from bottom to top. This ensures proper pressure distribution and prevents product deformation. There are also special devices that facilitate its installation. They can also be purchased in orthopedic stores.
It is advisable to wear compression garments in the morning, while still in bed: this is when the swelling of the legs is usually minimal, so that optimal compression of the veins can be achieved. It is also recommended that before putting on the pantyhose, you raise your legs for a few minutes and "work" your legs to further increase the flow of venous blood and lymph.
Anti-varicose compresses are sometimes worn for a long time, removed only in the evening before going to bed. Such recommendations can be given, for example, for post-phlebothrombotic syndrome (PFTS), thrombophlebitis and persistent edema syndrome. In other cases (with initial varicose veins), it is enough to wear such socks (pantyhose) only during periods of static or dynamic loading. The rules for wearing compression garments will be determined by your doctor.