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At least 127 records · Page 7Linked to original sources

PubMed2004

Below-knee elastic compression stockings to prevent the post-thrombotic syndrome: a randomized, controlled trial.

BACKGROUND: Because only limited evidence suggests that elastic stockings prevent the post-thrombotic syndrome in patients with symptomatic deep venous thrombosis (DVT), these stockings are not widely used. OBJECTIVE: To evaluate the efficacy of compression elastic stockings for prevention of the post-thrombotic syndrome in patients with proximal DVT. DESIGN: Randomized, controlled clinical trial. SETTING: University hospital. PATIENTS: 180 consecutive patients with a first episode of symptomatic proximal DVT who received conventional anticoagulant treatment. INTERVENTIONS: Before discharge, patients were randomly assigned to wear or not wear below-knee compression elastic stockings (30 to 40 mm Hg at the ankle) for 2 years. Follow-up was performed for up to 5 years. MEASUREMENTS: The presence and severity of the post-thrombotic syndrome were scored by using a standardized scale. RESULTS: Post-thrombotic sequelae developed in 44 of 90 controls (severe in 10) and in 23 of 90 patients wearing elastic stockings (severe in 3). All but 1 event developed in the first 2 years. The cumulative incidence of the post-thrombotic syndrome in the control group versus the elastic stockings group was 40.0% (95% CI, 29.9% to 50.1%) versus 21.1% (CI, 12.7% to 29.5%) after 6 months, 46.7% (CI, 36.4% to 57.0%) versus 22.2% (CI, 13.8% to 30.7%) after 1 year, and 49.1% (CI, 38.7% to 59.4%) versus 24.5% (CI, 15.6% to 33.4%) after 2 years. After adjustment for baseline characteristics, the hazard ratio for the post-thrombotic syndrome in the elastic stockings group compared with controls was 0.49 (CI, 0.29 to 0.84; P = 0.011). LIMITATIONS: This study lacked a double-blind design. CONCLUSIONS: Post-thrombotic sequelae develop in almost half of patients with proximal DVT. Below-knee compression elastic stockings reduce this rate by approximately 50%.

Adult↗

PubMed2002

Why insurers should reimburse for compression stockings in patients with chronic venous stasis.

BACKGROUND: Chronic venous stasis ulcers produce substantial morbidity rates and result in a significant expense to society. Fortunately, compression stockings (CS) have been found to reduce the rate of recurrence in patients with previous ulceration. Surprisingly, Medicare and other insurers do not reimburse the expense associated with CS or with patient education (Ed), which is essential to ensure compliance. METHODS: A Markov decision analysis model was used for analysis of the cost-effectiveness of a strategy of reimbursement for CS and Ed (prophylaxis) versus one that does not supply these resources in a 55-year-old patient with prior venous stasis ulceration. The mean time to ulcer recurrence (53 months with CS+Ed; 18.7 months without prophylaxis), the mean time for ulcer healing (4.6 months), the probabilities of hospitalization (12%) and amputation (0.4%) after the development of an ulcer, and quality-adjustment factors (0.80 during ulcer treatment) were derived from the literature. The cost of CS ($300/year) and Ed ($93 for initial evaluation; $58/year; $40/recurrence) and the medical cost of ulcer treatment (average cost, $1621/recurrence) were calculated from our hospital cost accounting system. RESULTS: A strategy of CS and Ed was cost saving, with 0.37 quality-adjusted life years and $5904 saved, compared with a strategy that does not provide these resources. The inclusion of loss of revenue related to absence from work in the analysis increased cost savings to $17,080 during the patient's lifetime. With sensitivity analysis, CS and Ed remained cost-effective (lifetime cost per quality-adjusted life year saved, <$60,000) if amputations and the cost of ulcer treatment were eliminated or if the cost of prophylaxis was increased to 600% of the base-case. The mean time to recurrence in patients with CS and Ed needed to be reduced from 53 months to 21.1 months before this strategy was no longer cost-effective. CONCLUSION: Prophylactic CS and Ed in patients with prior venous stasis ulceration are cost saving, even with the most conservative of assumptions. Insurers should routinely reimburse for these interventions.

Bandages↗

PubMed2005

Intermittent pneumatic compression stocking prophylaxis against deep venous thrombosis in anterior cervical spinal surgery: a prospective efficacy study in 200 patients and literature review.

STUDY DESIGN: Intermittent pneumatic compression stockings (IPC) alone were prospectively used to avoid deep venous thrombosis (DVT) and pulmonary embolism (PE) in 100 consecutive patients undergoing single-level anterior corpectomy/fusion (ACF) and in 100 patients having multilevel ACF/posterior fusion. OBJECTIVES: To determine the optimal prophylaxis against DVT and PE for patients undergoing anterior cervical spinal surgery. BACKGROUND DATA: Mini-heparin and low-dose heparin prophylaxis in neurosurgery poses a 2% to 4% risk of major postoperative hemorrhage with resultant neurologic sequelae. METHODS: Prophylaxis consisted of IPC alone. Doppler studies of the lower extremities were routinely obtained 2 days after surgery. Single-level ACF (100 patients) addressed two-level disc disease, spondylostenosis, and ossification of the posterior longitudinal ligament (OPLL). One hundred patients undergoing multilevel ACF (3+ levels) with posterior fusion (C2-T1) exhibited OPLL/spondylostenosis. RESULTS: One patient undergoing single-level ACF developed DVT/PE 6 days after surgery; she exhibited Factor V Leiden mutation (hypercoagulability syndrome). Although 7 patients undergoing circumferential surgery developed DVT 2 to 14 days following surgery (mean, 7.15 days), only two clots localized in the iliac veins resulted in PEs (days 10 and 14 after surgery). CONCLUSIONS: IPCs were as effective for prophylaxis against DVT/PE for 100 patients undergoing single-level ACF and for 100 having circumferential procedures as existing therapies (mini-heparin and low-dose heparin), without the risk of hemorrhage. However, the 1% and 2% respective rates of PE were comparable to frequencies of PE encountered in other cranial/spinal series using mini-heparin and/or low-dose heparin regimens but avoided the 2% to 4% risk of major postoperative hemorrhage.

Bandages↗

PubMed1995

A comparative clinical trial of graduated compression stockings and O-(beta-hydroxyethyl)-rutosides (HR) in the treatment of patients with chronic venous insufficiency.

As overall conclusions from this study, and the two preceding comparable trials in which TcPO2 was measured in patients with (8) and without (7) stockings, we propose that: All patients with symptoms and oedema of CVI should be advised to wear suitable compressive stockings (this study); if they do wear stockings, then additional benefit may be derived from treatment with HR (8); for patients who are reluctant to wear stockings, for a variety of reasons, or in whom stockings may be contraindicated (e.g. mixed arterio-venous disease), then HR is an acceptable alternative (7 and this study).

Adult↗

PubMed1999

Vascular surgical society of great britain and ireland: randomized controlled trial of heparin plus graduated compression stocking for the prophylaxis of deep venous thrombosis in general surgical patients

BACKGROUND: A randomized controlled study was undertaken to compare heparin with heparin plus graduated compression stockings (Brevet Tx, Seton Healthcare) in the prophylaxis of deep vein thrombosis (DVT) following abdominal surgery. METHODS: Sixty high-risk patients were recruited if they met at least two of the following criteria identified as predisposing to DVT: age greater than 39 years, malignancy, varicose veins, cardiac disease or hypertension, diabetes mellitus, obesity or previous thromboembolic episode. All patients received subcutaneous heparin and were randomized to receive Brevet Tx to either the right or left leg before surgery. The stocking was worn for 2 weeks after surgery. The patients underwent duplex imaging before surgery, and at 3, 6 and 14 days after operation. All scans were performed by one sonographer. The policy was to perform a venogram where a positive result was indicated by duplex scanning. RESULTS: Fifty-six patients completed the study. Six patients (11 per cent) suffered a DVT in the non-stockinged leg, but none in the stockinged leg (P = 0.016, McNemar's test). The DVTs occurred on days 3, 6, 7, 8, 9 and 12 following surgery. CONCLUSION: Brevet Tx in addition to low-dose subcutaneous heparin significantly reduced the incidence of DVT in high-risk patients undergoing abdominal surgery.

Journal Article↗

PubMed1992

Treatment of fixed flexion deformities of the knee in rheumatoid arthritis using the Flowtron intermittent compression stocking.

Thirty established fixed flexion deformities of the knee in 18 rheumatoid arthritis patients were studied prospectively to assess the results of 8 weeks of out-patient treatment using the Flowtron intermittent compression stocking. A 44% mean correction of the fixed flexion deformity was obtained from an initial mean of 29 +/- 1 degrees to 16 +/- 1 degrees (P less than 0.001). More than 85% of this correction was obtained in the first 4 weeks of treatment. There was a significant correlation between the correction obtained and the inflation pressure (P less than 0.05), but the time of daily use (minimum 60 min) was not a significant factor. The modified Stanford Health Assessment Disability Index fell from an initial mean of 2.17 to 2.03 (P less than 0.01).

Ambulatory Care↗

PubMed2004

Effect of graduated compression stockings on limb oxygenation and venous function during exercise in patients with venous insufficiency.

Despite the established role of compression as the basis for nonoperative treatment of chronic venous insufficiency (CVI), its mechanism of action remains unclear. Near-infrared spectroscopy (NIRS) provides continuous noninvasive monitoring of changes in tissue oxyhemoglobin (HbO2) and deoxyhemoglobin (Hb). We applied NIRS to evaluate the effect of graded stockings on venous function and calf muscle oxygenation during exercise in patients with CVI. Ten patients (age 56 +/- 5 years) with CVI were rested in supine posture for 20 minutes. NIRS optodes were attached to the calf. Venous function was assessed in each patient with and without graded compression stockings (classes I to III) at rest in the supine position, standing, with 10 tiptoe exercises, and on standard walking at 1.6 km/h for 5 minutes. Venous function was assessed by measuring changes in Hb and total hemoglobin (HbT) during the test, and muscle oxygenation was assessed by the oxygenation index (HbD), which is the difference between HbO2 and Hb. Standing without stockings caused a significant increase in Hb concentration by 10.75 +/- 2.24 micromol/L compared with the supine position (p < .001). This value was reduced when stockings were applied to 6.38 +/- 2.75 micromol/L with class III stockings (p = .005). During tiptoe exercise, the residual Hb concentration value without stockings was 7.62 +/- 2.12 micromol/L compared with 5.88 +/- 2.87, 3.77 +/- 3.37, and 3.46 +/- 2.73 micromol/L for class I, II, and III stockings, respectively. The reduction in Hb concentration reached significance with class II and III stockings compared to without stockings (p = .04). The HbT concentration was also reduced during tiptoe exercise, with increasing compression from 15.46 +/- 5.31 micromol/L without compression to 11.52 +/- 4.26 pmol/L with class III stockings (p = .048). During walking, the Hb concentration was 11.40 +/- 3.10 pmol/L without stockings, decreasing significantly (p < .001) and progressively to 8.49 +/- 3.24, 7.71 +/- 3.51, and 6.89 +/- 3.16 micromol/L with class I, II, and III stockings, respectively. Limb oxygenation (as measured by HbO2 concentration) during walking exercise, however, increased with higher-compression stockings and reached significance with class III stockings only (p = .03). In patients with venous insufficiency, graduated compression stockings may achieve their beneficial effects by reducing venous pooling and improving deeper tissue oxygenation.

Adult↗

PubMed1987

Evaluation of the efficacy of elastic compression stockings in prevention of hypotension during epidural anaesthesia for elective caesarean section.

The ability of graduated compression elastic stockings to prevent hypotension during elective epidural caesarean section was evaluated. Twenty women were randomly assigned to two groups of ten, one group being fitted with the stockings. The incidence and degree of hypotension were the same in both groups. Graduated compression elastic stockings are of no benefit in reducing the incidence of maternal hypotension during caesarean section.

Anesthesia, Epidural↗

PubMed2006

A survey of pregnant women on the use of graduated elastic compression stockings on the antenatal ward.

Pulmonary thromboembolism is the leading direct cause of maternal death in the UK. This direct approach structured questionnaire survey was carried out on 100 randomly chosen pregnant in-patients in a London teaching hospital: (a) to assess the quality and frequency of advice given to them by the healthcare professionals on the use of graduated elastic compression stockings (GECS) as a primary physical prophylaxis against venous thromboembolism (VTE) and (b) to find out the rate of compliance and the possible reasons for non-compliance of their use. The information and advice given to pregnant patients by healthcare professionals are generally of good-to-excellent quality, but not universally offered. A total of 40% of mothers wore the GECS all the time, while 38% did not wear them at all. Among the non-wearers, the two major groups were those who did not receive any advice (28%) and those who found them uncomfortable (18%). All healthcare professionals should be aware of the potential risks of VTE, and routinely educate and advise the pregnant women-at-risk on the use of GECS.

Adolescent↗

PubMed1990

Pneumatic compression stockings. Preventing deep vein thrombus and pulmonary embolus.

As patient advocates, perioperative nurses are vital to the safety and protection of the surgical patient. They are responsible for providing a safe environment and efficient and economical nursing care. Using the treatment options available, they can optimize the patient's surgical experience and postoperative recovery. OR nurses and managers can potentially prevent extended hospital stays and expense for patients by requiring pneumatic compression stockings and anticoagulants as the standard of care in their operating rooms. Prophylaxis is the key to reducing the incidence of DVT and PE. The perioperative nurse, cognizant of the effects of general anesthesia, Virchow's triad, and inherent patient risk factors, can greatly contribute to reducing the incidence of DVT and PE morbidity and mortality by using these treatment modalities as ordered by the attending physician.

Bandages↗

PubMed1992

[Efficacy of elastic compression stockings and administration of calcium heparin in the prevention of puerperal thromboembolic complications].

Post-partum superficial and deep venous thrombosis are still an important obstetric problem. Varicose veins of the lower limbs are closely associated epidemiologically and pathogenically with venous thrombosis. A controlled group of 1,588 parturients was studied to single out other risk factors and to ascertain the prevalence of thrombosis. A group of 1,464 parturients was treated with graduated compression stockings, in low risk patients, adding preventive treatment with low dose heparin in high risk patients. The prevalence of post-partum venous thrombosis was reduced from 4.3%, in the control group, to 0.9% in the study group: in women who received preventive treatment, the prevalence of thrombosis diseases was decreased over 90%.

Bandages↗

PubMed2004

Compression stockings reduce occupational leg swelling.

BACKGROUND: Evening edema of the legs is a physiologic phenomenon occurring after sitting and standing. OBJECTIVE: The objective of this study was to investigate which compression pressure is necessary to prevent leg swelling. METHODS: In 12 volunteers, the volume of both lower legs was measured in the morning and 7 h later, the difference being defined as evening edema (mL). The procedure was carried out for 4 days, in which the subjects wore below-knee stockings of different compression levels alternatively on one leg only in a random order. Compression pressure was assessed using the HATRA device. RESULTS. The average evening edema of the noncompressed legs was 62.4 mL on the left side and 94.4 mL on the right side (n.s.). Evening edema was significantly reduced to 40.3 mL by light support stockings, to -34.1 mL by compression class A, to -39.6 by compression class I, and to -59.1 mL by compression class II. Mainly stockings exerting a pressure above 10 mmHg improved subjective symptoms. CONCLUSION: Calf-length compression stockings with a pressure range between 11 and 21 mmHg are able to reduce or totally prevent evening edema and may therefore be recommended for people with a profession connected with long periods of sitting or standing.

Adult↗

PubMed2000

Lipodermatosclerosis and compression stockings.

Explore the source record for details and available documents.

Bandages↗

PubMed1980

Value of graduated compression stockings in deep venous insufficiency.

The effect on elastic stockings on ambulatory venous pressure was investigated in 22 limbs with deep venous insufficiency. The failure of some elastic stockings to reduce the ambulatory venous pressure in some limbs is due to the lack of graduated compression, which is caused by ankle-calf disproportion--narrow ankles and wide calves. This can be recognised by using the pressure-girth profile and corrected by specially made stockings with increased tension at the ankle. A pressure-girth profile established for each stocking enabled the exact compression exerted by the stocking along the length of each limb to be determined. Elastic stockings exerting a graduated compression between ankle and calf induced a reduction in the ambulatory venous pressure in all but one limb. The greater the degree of graduated compression between ankle and calf exerted by the stocking, the greater the fall in ambulatory venous pressure. This may explain the beneficial effect of compression in limbs with venous ulceration.

Ankle↗

PubMed1999

The effect of posture and exercise on elastic stocking compression at different sites of the leg.

BACKGROUND: In compression therapy, the importance of the degree of pressure has been emphasized. The aim of this study was to examine the influence of posture and exercise on the compression at different sites of the leg. PATIENTS AND METHODS: In 16 normal volunteers, the pressure was determined simultaneously at 5 sites on the leg during lying, sitting, standing, walking, running, knee-bending exercise and squatting using an air pack type analyzer. Pressure was measured under 3 experimental conditions: with a thigh-length gradient stocking, with foam rubber pads included under the elastic stocking, and after removal of both elastic stocking and compression pads. RESULTS: When the stocking was worn, a pressure gradient was observed in the proximal direction during the sequence from the supine position to running. When the pads were included, the pressure in the supine position was significantly elevated at all sites examined, and the graduated pressure drop was also maintained from supine position to running. However, the pressure at the tibia was significantly higher than that at the gastrocnemius in both supine and sitting positions when the pads were used, while no significant difference was observed between both sites in the standing position. A marked increase in pressure at the ankle, gastrocnemius, and hollow of the knee was observed during squatting when the stocking was worn either with or without pads, while a significant decrease in pressure was observed at the tibia. CONCLUSION: The pressure exerted by elastic stockings varies with the posture and exercise. Furthermore, the changes in pressure vary from site to site.

Adolescent↗

PubMedDate not supplied

The use and benefits of compression stocking aids.

An exploratory study was undertaken to trial various stocking aids designed for use with compression and antiembolic hosiery. Their features were identified and assessed by professionals for ease of use. Factors affecting the choice of stocking aids were the style and grade of stockings and the physical ability of users.

Bandages↗

PubMed1991

[Compression stockings contra ace-bandages in the treatment of acute ankle distorsions. A prospective randomized study].

Sprained ankles are most often treated with ace-bandages. The aim of this study was to investigate the effect of compressing antiembolism stocking (T.E.D.) versus the ace-bandage in a prospective randomised trial. Evaluation was based on the duration of pain, swelling, limp and absence from daily routines (job, daily activity and sport). The study included 149 patients. We found no difference between the two treatments, on the basis of 95% confidence interval at the difference between the treatments. On the basis of this trial we cannot recommend one treatment rather than the other, but it must be borne in mind that the ace-bandage is cheaper.

Acute Disease↗

PubMed1996

[Modification of the flexibility of the upper and lower ankle joint by medical compression stockings].

Using a special measurement equipment the motility range of the ankle joint and the talo-calcaneo-navicular joint in healthy young volunteers was compared with and without compression hosiery. There was no limitation in joint motility using the stockings of moderate compression (german compression class 1 and 2) but a reduced motility using strong compression hosiery (german compression class 3 and 4) was found especially in the ankle joint. This difference was significant in the products of two manufacturers.

Adolescent↗