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PubMed1987

Prevention of venous thromboembolism after general surgery. Cost-effectiveness analysis of alternative approaches to prophylaxis.

A number of methods of prophylaxis can reduce the risk of postoperative venous thromboembolism in patients undergoing general surgery. The cost-effectiveness of several of these--low-dose subcutaneous heparin, intermittent pneumatic compression, graduated compression stockings, heparin plus dihydroergotamine, heparin plus stockings, and intermittent pneumatic compression plus stockings--was assessed by pooling data from published reports of randomized controlled trials. Using clinical protocols, costs for prophylaxis, diagnosis, and treatment of venous thromboembolism were determined. The expected outcomes and costs of each strategy were then calculated using techniques of decision analysis. The results indicate that stockings are the only prophylactic method that is actually cost-saving. Costs of care average $34 less per admission for patients using stockings than for those receiving no prophylaxis. Most other methods of prophylaxis further reduce thromboembolic risk, but increase costs by $50 to $88 per patient relative to costs for the use of stockings. Differences in the cost-effectiveness of these prophylaxis are more marked, ranging from about $50,000 to almost $500,000 per additional life saved.

Clothing↗

PubMed1987

A cost-effectiveness analysis of prophylaxis against deep-vein thrombosis in major orthopedic surgery.

A number of methods of prophylaxis can reduce the likelihood of postoperative deep-vein thrombosis in patients undergoing major orthopedic surgery. Using techniques of decision analysis, we examine the cost-effectiveness of several of these--warfarin sodium, low-dose subcutaneous heparin sodium, graduated compression stockings, intermittent pneumatic compression, heparin plus dihydroergotamine mesylate, and heparin plus stockings--compared with clinical diagnosis and treatment only. Our results show that 153 deaths per 10 000 patients occur when no prophylaxis is used; with most prophylaxis, this number is at least halved, and the most effective methods may reduce the number of deaths by three fourths. In addition, all of the prophylaxis considered are cost saving: average costs of care (including prophylaxis costs) are reduced by +19.40 to +181.60 per patient. Prophylaxis against deep-vein thrombosis in major orthopedic surgery therefore saves both lives and health care dollars.

Cost-Benefit Analysis↗

PubMed2005

[Routine nursing measures for thrombosis prevention in a university hospital].

A literature search on the subject of thrombosis prevention showed that there have been changes in preventive nursing measures in the last three decades. Data on preventive measures as actually employed at the different Clinics of the Innsbruck Medical University were gathered with the help of written questionnaires (completed by 192 staff nurses and 111 nursing students) with the aim of instituting improvements in such measures in actual practice. Our investigation showed that 56.9% of the participants did not know what the appropriate time was for discarding graduated elastic compression stockings for antithrombotic prophylaxis; 72.7% reported that they measured patients' legs for proper fit only seldom or not at all. 77.5% said that patients refused to wear the elastic stockings during the night. Only 22.3% reported that the compression device was worn by patients 24 hours a day. 82.5% had not participated in any continuing education programmes on thrombosis prophylaxis in the past five years. According to 42.3% of study participants, nursing measures for thrombosis prevention must be carried out jointly by physician and nurse. Based on this investigation, we have compiled a booklet of guidelines to be used for teaching nursing students and for continuing education of staff nurses, and have raised our internal standards to comply with the state of the art in thrombosis prevention. We plan to investigate antithrombotic measures currently in place in the area of intensive care. It is also planned to invite the opinion of patients on the matter of wearing compression stockings for thrombosis prophylaxis in order to gain some understanding of the reasons why patients refuse to wear them at night.

Adult↗

PubMed2002

Injection sclerotherapy for varicose veins.

BACKGROUND: Injection sclerotherapy for varicose veins has been used widely since 1963, following popularisation of the technique by Fegan. The treatment aims to obliterate the lumen of varicose veins or thread veins, however, there is limited evidence regarding its efficacy. OBJECTIVES: To determine whether sclerotherapy is effective in terms of symptomatic improvement and cosmetic appearance; has an acceptable complication rate; and to define rates of symptomatic or cosmetic varicose vein recurrence following sclerotherapy. SEARCH STRATEGY: Publications describing randomised controlled trials (RCTs) of injection sclerotherapy for varicose veins (excluding comparisons with surgery) were sought through EMBASE and MEDLINE (from inception to March 2001) and hand-searching relevant journals, using the search strategy described by the Cochrane Peripheral Vascular Diseases Review Group. Bibliographies of papers identified were examined for further RCTs. Manufacturers of sclerosants were contacted for further trial information. SELECTION CRITERIA: RCTs of injection sclerotherapy versus graduated compression stockings or 'observation', or comparing different sclerosants, doses and post-compression bandaging techniques on patients with symptomatic and/or cosmetic varicose veins or thread veins were considered for inclusion in the review. DATA COLLECTION AND ANALYSIS: Ten studies were included in the analysis. These compared: sodium tetradecyl sulphate (STD) versus an alternative sclerosant; sclerosant with or without local anaesthetic; application of Molefoam versus Sorbo pads to injection sites; elastic compression bandaging versus conventional bandaging; and short-term bandaging versus standard bandaging. Data were abstracted by both authors. MAIN RESULTS: No RCTs compared sclerotherapy to graduated compression stockings or other non-surgical treatments. Two studies compared STD to alternative sclerosants and found no significant differences in outcome or complication rates. Adding local anaesthetic to sclerosant reduced the pain from injection (one study) but had no other effects. Comparison of Molefoam and Sorbo pad pressure dressings found no difference in outcome for erythema (redness) or successful sclerosis. The degree and duration of elastic compression had no significant effect on varicose vein recurrence rates, cosmetic appearance or symptomatic improvement. Increased compression prevented slipping of dressings but caused increased discomfort, as did increasing duration of compression. REVIEWER'S CONCLUSIONS: Evidence from RCTs suggests that type of sclerosant, local pressure dressing, degree and length of compression have no significant effect on the efficacy of sclerotherapy for varicose veins. This supports the current place of sclerotherapy in modern clinical practice, which is usually limited to treatment of recurrent varicose veins following surgery, and thread veins. A comparison of surgery versus sclerotherapy would be valuable.

Bandages↗

PubMed2004

[Compressive therapy after varicose vein surgery: results of a French national inquiry].

OBJECTIVES: A survey on postoperative compression after varicose vein surgery was undertaken in 2001 among surgeons of the French-speaking Vascular Surgery Society as well as non-members with a heavy caseload in varicose vein surgery. The aims of the study were to 1) identify the various medical devices and protocols used postoperatively, 2) estimate the frequency and duration of use, and 3) identify the surgeon's rationale for prescribing postoperative compression. The first part of the inquiry was devoted to surgical procedures and has been previously published (J Mal Vasc 2003; 28: 277-86). MATERIAL AND METHODS: A questionnaire with 11 items for postoperative treatments and a patient form was mailed to 675 surgeons. RESULTS: The response rate was 41.5% (280 surgeons). Results were assessed by a scientific committee. Surgeons were classified into different groups according to their membership in the French-speaking Vascular Surgery Society or not, the type of practice (private, public hospital, mixed), and caseload. Compression was widely used (97.1%). It was the only postoperative treatment for 25.2% of the surgeons, was associated with anticoagulant treatment for 38.8% or non-steroidal antiinflammatory drugs for 11.2%. Prescription was evidence-based for only 11.6%. Compression therapy was mainly started postoperatively (93.2%). Elastic bandages (long stretch) were used by 87%. Duration of bandage therapy was variable (less than 8 days for 38.8%, 8-15 days for 24.5%). After bandage therapy, medical compression stockings (above knee 74.7%) or French class II (77.9%) were used. Compression stockings were prescribed for 8-15 days or 15-30 days by 12.7% and 84.6% of the surgeons respectively. Prolonged postoperative treatment was not common (28%) and was prescribed for patients with trophic changes.

Bandages↗

PubMed2006

Interventions for leg edema and varicosities in pregnancy. What evidence?

Leg oedema from venous insufficiency is not dangerous but it can cause women symptoms such as pain, feelings of heaviness, night cramps and paraesthesiae. Leg oedema can be a sign of pre-eclampsia when associated with raised blood pressure or proteinuria. The objective of this review was to assess the effects of treatment to relieve the symptoms associated with varicosity in pregnancy and to reduce leg oedema. We searched the Cochrane Pregnancy and Childbirth Group trials register in October 2004 for randomised trials of any form of treatment for varicosity and or leg oedema in pregnancy. Trial quality was assessed and data were extracted. Four trials of three different treatments were included. In one trial, women given rutoside capsules in the last 3 months of pregnancy noted an improvement in symptoms compared with placebo (relative risk 0.54 95% CI 0.32, 0.89). They had a decrease in ankle circumference at 36 weeks' gestation after 8 weeks of treatment, while women given placebo had a small increase. In one trial, women with ankle oedema had a small non-significant reduction in lower leg volume when treated with external pneumatic intermittent compression for 30 min. In another trial compression stockings prophylactically reduced the emergence of leg symptoms but not venous varicosities (relative risk 0.74 95% CI 0.59, 0.93). Lymphatic reflexology was studied in too few women to draw conclusions. In conclusions, rutosides appear to relieve symptoms of venous insufficiency in late pregnancy. However, it is not known if the drug is safe in pregnancy. External pneumatic compression appears to reduce ankle swelling and compression stockings reduce leg symptoms but not varicose veins.

Capillary Fragility↗

PubMed2005

A review of the risks and benefits of differing prophylaxis regimens for the treatment of deep venous thrombosis and pulmonary embolism in neurosurgery.

BACKGROUND: Annually, 2 million people in the United States develop deep venous thrombosis (DVT), and nearly 100,000 sustain fatal pulmonary emboli. Prophylaxis against DVT/pulmonary embolism (PE) is a critical issue, and options include elastic stockings, intermittent pneumatic compression stockings, low-dose unfractionated heparin (5000 U every 8-12 hours), and low molecular-weight heparin (ie, enoxaparin and dalteparin). The risks and benefits associated with different prophylaxis regimens used in the prevention of DVT and PE in neurosurgical procedures were analyzed. METHODS: Neurosurgical studies focusing on different methods of prophylaxis used for the prevention of DVT and PE were reviewed. The efficacy, risks, and benefits of varied treatment options were evaluated, with particular emphasis on minor and major hemorrhages occurring where heparin-based protocols were used. RESULTS: In Flinn et al series (Arch Surg. 1996;131(5):472-80), the incidence of DVT was greater for cranial (7.7%) than spinal procedures (1.5%). Although intermittent pneumatic compression devices provided adequate reduction of DVT/PE in some cranial and combined cranial/spinal series, low-dose subcutaneous unfractionated heparin or low molecular-weight heparins further reduced the incidence, not always of DVT, but of PE (Br J Neurosurg 1995;9(2):159-63; J Intensive Care Med 2003;18(2):59-79). Nevertheless, low-dose heparin-based prophylaxis in cranial and spinal series risks minor and major postoperative hemorrhages: 2% to 4% in a cranial series, 3.4% minor and 3.4% major hemorrhages in a combined cranial/spinal series, and a 0.7% incidence of major/minor hemorrhages in a spinal series (J Neurosurg 2003;99(4):680-4; Neurosurgery 1986;18(4):440-5; Eur Spine J 2004;13(1):1-8; J Intensive Care Med 2003;18(2):59-79). CONCLUSIONS: Although mechanical prophylaxis provided effective prophylaxis against DVT/PE in many series, the added efficacy of low-dose heparin regimens has to be weighed against risks of major postoperative hemorrhages and their neurological sequelae.

Bandages↗

PubMed2001

Prophylaxis of Venous Thrombosis.

Mechanical measures such as graduated compression stockings and intermittent compression boots are available for venous thrombosis prophylaxis, but compliance may be limited. Plantar venous pneumatic compression devices have attained widespread acceptance by both patients and nurses because of their comfort and compact size, but their track record for efficacy is poor. Inferior vena cava filters prevent pulmonary embolism, but do not halt the thrombotic process or prevent venous thrombosis. Pharmacologic prophylaxis traditionally has relied upon minidose unfractionated heparin; however, re-examination is warranted in the face of increasingly ill and complex patients. My opinion is that small, fixed doses of once-daily low molecular weight heparin will eventually replace minidose unfractionated heparin as the standard pharmacologic prophylaxis regimen for most surgical and medical patients. Prolongation of prophylaxis after hospital discharge should receive increased emphasis. Most patients being transferred to a skilled nursing facility should receive venous thromboembolism prophylaxis. Similarly, most patients undergoing total hip or knee replacement should receive prolonged preventive regimens, with at least 1 month of anticoagulation. Despite advances, certain aspects of venous thrombosis prophylaxis remain problematic. First, a surprisingly high number of hospitalized patients develop venous thrombosis because of failed (rather than omitted) prophylaxis. Second, many patients in intensive care have a combination of peripheral vascular disease and active bleeding (usually gastrointestinal) that precludes mechanical or pharmacologic prophylaxis. Third, neurosurgical patients undergoing craniotomy for brain tumors suffer a high rate of venous thrombosis and major pulmonary embolism despite the routine use of combined mechanical and pharmacologic prophylaxis. My opinion is that these three areas, in addition to the hospital culture of prophylaxis, should receive increased attention in an effort to prevent venous thromboembolism.

Journal Article↗

PubMed1999

Thromboembolic complications after major thoracolumbar spine surgery.

STUDY DESIGN: Adult spinal surgery patients were studied prospectively to determine the incidence of subclinical deep venous thrombosis. An overlapping group of patients was reviewed retrospectively for symptomatic thromboembolism. OBJECTIVES: To determine the incidence of symptomatic and asymptomatic thromboembolism in spinal surgery patients. SUMMARY OF BACKGROUND DATA: Although thromboembolic complications are known to occur after spinal operations, there are limited published data on the incidence of pulmonary embolus or deep venous thrombosis after major spinal surgery. METHODS: One hundred sixteen adult spinal surgery patients were examined with duplex ultrasound to determine the incidence of deep venous thrombosis. Seventy-three of these patients also underwent lung perfusion scans to look for subclinical pulmonary embolism. A retrospective review was conducted of symptomatic thromboembolic complications occurring in a 2-year period at the authors' center. Three hundred and eighteen major spinal reconstructive procedures were performed during the period reviewed, which included the period of the prospective study and therefore the patients of the prospective group. Thigh-length compression stockings and pneumatic compression leggings were used for prophylaxis in all patients. RESULTS: One patient had an asymptomatic iliac vein thrombosis, and seven patients had symptomatic pulmonary embolism (2.2%). Six of the symptomatic pulmonary emboli occurred after combined anterior/posterior spinal fusions (6%), whereas only one occurred after posterior decompression and fusion (0.5%). CONCLUSIONS: Duplex ultrasound appeared insensitive for diagnosing clots before embolization in this patient group. Simple mechanical prophylaxis for thromboembolism, which may be adequate for patients undergoing posterior procedures, may not be as protective for patients undergoing combined anterior/posterior spine surgery.

Female↗

PubMed2004

Inferior vena cava filters prevent pulmonary emboli in patients with metastatic pathologic fractures of the lower extremity.

The records of 47 consecutive patients with metastatic pathologic fractures of the lower extremity were analyzed with respect to thromboembolic complications. All patients were unable to receive pharmacologic deep venous thrombosis prophylaxis, and were stratified into two groups, based on use of an inferior vena cava filter. Group I (n = 24) consisted of patients who had an inferior vena cava filter plus mechanical deep venous thrombosis prophylaxis (compression stockings and sequential compression boots); Group II (n = 23) consisted of a group of patients receiving only mechanical deep venous thrombosis prophylaxis. All patients had routine lower extremity venous duplex imaging preoperatively, postoperatively, and before hospital discharge. At final followup, patients were examined for deep venous thrombosis and reviewed for thromboembolic events. At a mean followup of 11.5 months, Group I had two detectable deep venous thromboses and no pulmonary emboli; Group II had one detectable deep venous thrombosis and five pulmonary embolisms. In Group II, 40% (two of five) of pulmonary embolisms were fatal, yielding an 8.7% (two of 23) group mortality rate. Overall, the entire group had an approximately 17% deep venous thrombosis rate. Only 6.4% (three of 47) of deep venous thromboses were detectable by standard duplex imaging. The majority of deep venous thromboses (five of eight, 62.5%) were nondetectable by duplex imaging. Overall, a 4.3% (two of 47) death rate was attributable to pulmonary embolism. In contrast, an 8.6% (four of 47) mortality rate occurred in Group II alone. All pulmonary embolisms occurred in patients who did not receive an inferior vena cava filter. The majority of venous thromboses (62.5%) were not detectable on duplex scanning, therefore were thought to arise from the pelvic venous system. Complications related to inferior vena cava filter insertion were minimal. For patients with metastatic pathologic fractures of the lower extremities who are unable to receive pharmacologic deep venous thrombosis prophylaxis, the use of inferior vena cava filters, in conjunction with standard mechanical deep venous thrombosis prophylaxis, is a procedure that has a low risk and is useful adjunct to prevent fatal pulmonary embolisms.

Aged↗

PubMed1996

A deep vein thrombosis prevention program for patients undergoing long-term invasive epilepsy monitoring.

Some patients may require invasive monitoring techniques, such as implanted depth or subdural grid electrodes, prior to resection of the epileptogenic focus. The additive effect from the lack of anticoagulant therapy, due to the unique nature of invasive monitoring, constraints on mobility associated with continuous EEG recording, along with other risk factors predisposes patients to vessel occlusion. Deep vein thrombosis (DVT) is an unfortunate, potentially life-threatening and often overlooked post-surgical complication. A team approach in developing and implementing a DVT prevention program has been successful in preventing pulmonary embolus in the invasive monitoring patient population. The use of graduated elastic compression stockings, intermittent pneumatic compressive devices and exercises are the major features of the program.

Bandages↗

PubMed2002

A comparison of two different prophylactic dose regimens of low molecular weight heparin in bariatric surgery.

BACKGROUND: Deep venous thrombosis (DVT) is a significant risk in patients undergoing surgery for morbid obesity and may be associated with significant morbidity and mortality. In a consecutive group of patients in one bariatric surgery practice, the initial group of patients who received prophylaxis for DVT was given enoxaparin 30 mg q12h while the later group was given enoxaparin 40 mg q12h. METHODS: 481 patients who underwent primary and revisional bariatric surgery over 38 months (October 1997-December 2000) were evaluated. All patients received a multi-modality DVT prophylaxis protocol that included: early ambulation, graduated compression stockings, intermittent pneumatic compression, and enoxaparin (LMWH) in two dosage groups. The first 92 patients (19%) in the series (Group I) received LMWH 30 mg q12h while the subsequent 389 patients (81%) (Group II) received LMWH 40 mg q12h. RESULTS: Group I patients were not different from Group II patients in body mass index (BMI) (51.7 vs 50.3 kg/m2), age (43.7 vs 44.3 yrs), sex (men 20.2% vs 15.8%) or history of previous DVT (3.2% vs 3.9%). Group I patients did have significantly longer procedure times (213 vs 175 min, p < 0.05) and hospital stays (5.67 d vs 3.81 d, p < 0.05) than Group II. There were a total of 7 (1.4%) postoperative DVT complications. 5 DVT complications occurred in Group I (5.4%) compared with 2 DVT complications in Group II (0.6%) (p < 0.01 by Fisher Exact Test two-tailed). One patient in each group required treatment for hemorrhage. CONCLUSION: A multi-modality prophylaxis treatment protocol in patients undergoing bariatric surgery is feasible and achieves a low incidence of postoperative DVT complications. The use of a higher dose of enoxaparin, 40 mg q12h, may reduce the incidence of DVT complications in patients following bariatric surgery without an increase in bleeding complications.

Adult↗

PubMed1985

Varicose veins: optimum compression following sclerotherapy.

There is uncertainty regarding the most satisfactory technique of lower limb compression following sclerotherapy for varicose veins. We have compared a standard bandaging technique with a high pressure compression stocking in a randomised trial. Efficacy was judged on the success of injections, complications of the treatment and patient satisfaction. In the stockinged legs 144 of 156 injections were successful, compared with 117 of 147 in the bandaged group (P less than 0.001) (Chi squared). The incidence of superficial thrombophlebitis was also reduced in the stocking group. In addition, the stocking technique costs less in materials than conventional bandaging. We would recommend compression stockings for evaluation in sclerotherapy of varicose veins.

Adult↗

PubMed2000

Compression and walking versus bed rest in the treatment of proximal deep venous thrombosis with low molecular weight heparin.

OBJECTIVE: The purpose of this randomized controlled trial was to evaluate the benefits of compression and walking exercises in comparison with bed rest in the acute stage of proximal deep venous thrombosis (DVT). METHODS: Forty-five patients with proximal DVT that was proved with compression ultrasound scan or phlebography were randomized into three groups. Group A consisted of 15 patients who received inelastic compression bandages (Unna boots on the lower leg, adhesive bandages on the thigh), and group B consisted of 15 patients who received thigh-length compression stockings, class II. Group C consisted of 15 patients who underwent bed rest and no compression. All patients received dalteparin, 200 IU/kg per body weight, subcutaneously every 24 hours. The clinical characteristics of the three groups were comparable. Primary end points were the reduction of pain assessed daily with the Visual Analogue Scale and the Lowenberg test, the reduction of leg circumference at the ankle and calf levels, and the improvement of clinical scores. The daily walking distance was measured with a pedometer. Safety parameters were ventilation-perfusion scans and duplex ultrasound scans performed on days 0 and 9. RESULTS: The daily walking distance was between 600 and 12,000 m in the compression groups and averaged 66 m in the bed rest group. The pain level showed a statistically significant reduction starting after the second day in the compression groups (A and B) and after 9 days in the bed rest group C (P <.05). The same was true for the measurement of leg circumference. Improvement of the clinical scores was significantly better in the compression groups compared with the bed rest group (P <.01). There was no significant difference concerning the occurrence of new pulmonary emboli and regression of thrombus diameter. Progression of thrombi in the femoral vein was greater and occurred more frequently in the bed rest group than in the other two groups (P = not significant). CONCLUSION: Mobile patients with acute proximal DVT treated with low molecular weight heparin should be encouraged to walk with compression bandages or medical compression stockings. The rate of resolution of pain and swelling is significantly faster when the patient ambulates with compression. The risk of pulmonary embolism is not significantly increased by this approach.

Acute Disease↗

PubMed1981

Effect of intermittent pneumatic and graduated static compression on factor VIII and the fibrinolytic system.

Intermittent pneumatic compression (IPC) or graduated static compression stockings, both effective mechanical methods in the prophylaxis of postoperative deep venous thrombosis, have been investigated in 50 patients regarding the effect of compression on the fibrinolytic system and factor VIII activators. All the patients were subjected to one of the two methods before operation upon varicose veins. In 38 patients IPC with a pressure of 40 mmHg was applied on one leg or arm for at least two hours. In 23 of these patients the compression pattern was slow, two minutes' inflation and two minutes' deflation period. In the remaining 15 patients the compression pattern was quick, three seconds' inflation, followed by 20 seconds' deflation, three cycles a minute. Twelve patients were treated with a compression stocking on one leg for about 24 hours before the operation. Blood samples for determination of fibrinolytic activity and factor VIII in plasma were obtained before and immediately after the end of compression and application of a stocking, respectively. Also the level of plasminogen activator activity (PA) in the vein wall was determined. Neither IPC nor the application of an elastic stocking had any demonstrable effect on the variables studied. In addition, the results did not vary with the rate (slow or quick) or with the duration of IPC, sex or site of application (arm or leg) of IPC. Blood samples from the compressed leg were also uninfluenced.

Adult↗

PubMed2003

Treatment of reticular leg veins with a 1064 nm long-pulsed Nd:YAG laser.

BACKGROUND: Millisecond-pulsed Nd:YAG lasers have been developed for the treatment of reticular leg veins. OBJECTIVE: We evaluated the effectiveness of a single treatment with a 50 millisecond 1064 nm Nd:YAG laser in the treatment of reticular veins of the lower extremity. METHODS: Twenty patients with reticular veins measuring 1.0 to 3.0 mm in diameter received one treatment with a 1064 nm Nd:YAG laser (Coolglide, Altus, Burlingame, Calif) at fluences of 100 J/cm(2) and 50 millisecond pulse duration. Symmetric matched areas that were left untreated served as the control. Eleven patients were pretreated with a topical anesthetic cream for 1 hour before treatment and wore compression stockings for 5 days after treatment. Nine patients were treated without topical anesthesia and did not wear compression stockings. Percent clearing and side effects were determined by 3 nontreating physicians (at each respective site) comparing projected Kodachrome images 1 month and 3 months after treatment. Patients also performed a self-assessment of their results. RESULTS: Two-thirds of vessels measuring 1 to 3 mm in diameter cleared more than 75% with one treatment. Larger vessels appeared to improve more than smaller vessels. Immediate treatment discomfort was tolerable. Side effects were minimal and included superficial thrombosis, delayed bruising, hyperpigmentation, and matting. CONCLUSION: Millisecond-pulsed Nd:YAG lasers used with 50 millisecond pulses are effective in the treatment of reticular leg veins.

Adult↗

PubMed1998

Measurements of calf muscle pump efficiency during simulated ambulation.

OBJECTIVE: To determine the acceptability and reproducibility of a novel method of measuring calf muscle pump efficiency (CMPE). If confirmed, to examine if the results had implications for the use of elastic compression stockings. EXPERIMENTAL DESIGN: A system devised to measure pressure/volume relationships in the calf during simulated ambulation and from which may be derived a value for CMPE. SETTING: A temperature/humidity controlled vascular laboratory. PARTICIPANTS: The study groups were normal subjects and patients with leg pain of more than three months duration with and without chronic venous insufficiency (CVI) identified using infra-red photoplethysmography. RESULTS: The system described is widely acceptable and reproducible (r = 0.923). Group analysis showed a significant reduction of CMPE in patients with CVI. However, CMPE varies widely in these patients. Some patients with insufficiency of the deep veins have a normal CMPE. CONCLUSIONS: These findings have implications for the use of elastic compression stockings and the degree of compression applied.

Adult↗

PubMed1996

Stockings and the prevention of recurrent venous ulcers.

BACKGROUND: Cost-effective therapy that heals ulcers rapidly and prevents recurrence would significantly impact patient care and the health system. OBJECTIVE: To evaluate compression stockings for treatment of venous ulcerations and prevention of recurrent ulceration; to analyze patient compliance; and to evaluate cost of compression stocking therapy. METHODS: Stocking therapy healed venous ulcers in 53 patients. The effect of continued stocking use on ulcer recurrence rate and treatment costs was evaluated. RESULTS: Twenty-five patients had good stocking usage; one developed recurrence (4%). Twenty-eight patients had bad or none usage; 22 had at least one recurrence (79%). Bad/none usage was associated with 31 of 32 (97%) recurrent ulcerations; good usage was associated with 52 of 58 (90%) nonrecurrent ulcers. Cost was a major reason for noncompliance. CONCLUSIONS: Continued stocking use after ulcer healing will prevent most recurrences and will provide a significant cost saving to the nation's health care budget.

Aged↗