COMPRESSION STOCKINGS

Compression stockings are the mainstay of preventing and treating venous insufficiency. While they have been in use for venous insufficiency since the time of the Ancient Greeks, it was Conrad Jobst who developed the modern compression stockings.  Jobst was a mechanical engineer by training and occupation, but he suffered from venous insufficiency and noted that he found great relief from his symptoms when he stood in swimming pools.  He realized when he was standing in water there was more pressure being applied to his legs near the bottom of the pool where the weight of the water was greatest.  From this insight, he developed the graduated compression stockings in which the pressure of the stocking was greatest at the foot and became less as went up the leg.

Graduated compression applied by venous support stockings has many beneficial effects:

• The pressure gradient ensures that blood flows upward toward the heart instead of refluxing downward to the foot or outward into the superficial veins.
• The graduated compression reduces the diameter of major veins, which increases the velocity and volume of blood flow.
• Compression lowers the pressure in the veins.
• Compression augment skeletal-muscle pump which helps improve venous return.
• and improve lymphatic drainage.
• It also improves the interaction between the venous, arterial and lymphatic systems.
• Compression also lowers the amount of inflammatory mediators cause by venous insufficiency.  It is thought that these inflammatory mediators (called cytokines) play a big role in the discomfort and ulceration in venous insufficiency.

Not only are compression stockings a useful adjunct to the over treatment of vein disease, most insurance companies, Medicare, and Medicaid require a trial of conservative medical management.

At the Alaska Vein Clinic, Dr. Artwohl will prescribe the proper compression stockings for your vein or lymphatic problem.

Compression stockings can be hard to put, especially in those patient that suffer from arthritis, or morbidly obese, are very weak.  Fortunately as you can see in the videos below, there are devices that make donning compressions stockings very easy.  At the Alaska Vein Clinic, we have these devices in the office and we can show you how to use them.

Today, compression stocking come in a variety of styles, colors, and patterns.  There are no long the ugly stockings your grandmother wore.  “There just too ugly,” is no longer an excuse not to wear them.

How to start with Compression Stockings

There are different lengths and compression strengths of compression.  If you are told that you would benefit from compression stockings, but have not been prescribed a specific regimen, here are a few things to keep in mind.

1. the longer the compressions stocking, the more expensive the stocking.
2. the more higher compression strength the more expensive the stocking.
3. you will not wear them if they are intolerably tight.

Therefore it makes sense to use the lowest compression that controls your symptoms.  If you not sure, start with 15 -20 mmHg knee-high stockings.  If these provide satisfactory relief then stick with those.  If they do not prevent aching and swelling, then go up to 20 – 30 mmHg.  If you find that you are developing swelling above the compression stockings (“muffin top”), then go to thigh-high.  If you find the thigh high stockings are helpful and but they don’t stay up, then try waist-high stockings.  If you are pregnant, they make special maternity support stockings.  You should not wear stockings higher than 20-30 without consulting a physician.

If you do not like your toes or feet covered, they make knee and thigh stockings that are toeless or are just sleeves that go down to the ankle and do not cover the feet at all.  If you choose these styles, discontinue wearing them if you develop foot swelling.

Keep in mind, there are many different brands.  Some people have success with one brand, but don’t have success with another.  Sometimes there has to be a bit of experimentation or shopping around before you find the brand that works for you.

If at anytime you develop pain wearing support stockings you should take them off immediately and consult your physician or call us at the Alaska Vein Clinic.

WARNING:  

Diabetics and people who suffer from peripheral arterial disease should be very careful when wearing support hose and should only do so under a physician’s supervision.  Even mild compression can compromise arterial circulation in these patients and cause severe complications in patients with compromised blood flow.

HOW COMPRESSION STOCKINGS WORK

Chung Sim Lim, and Alun H. Davies CMAJ 2014;186:E391-E398  ©2014 by Canadian Medical Association