VARICOSE VEINS – USING COMPRESSION STOCKINGS
This abstract appeared in http://www.medscape.com as an abstract relating to varicose veins. It is rather technical. But gives more than superficial treatment to explaining why compression stocking are used as a non-surgical option for the treatment of varicose veins
Background: The superficial venous system is most often affected by varicose veins. Graduated compression stockings (GCSs) are a recognized effective nonsurgical option to prevent and treat lower limb varicose veins.
Objective: The objective of the present study was to investigate the cutaneous surface pressure exerted by GCSs along the courses of main superficial veins of the lower limb.
Methods and Materials: Cutaneous surface pressures along the paths of long and short saphenous veins applied by different kinds of GCSs were examined by using pressure sensors (Tekscan, Inc., Boston, Mass) and a multichannel monitoring system in 6 healthy women tested in 7 different body postures.
Results: Tested location, body posture, and types of compression stocking significantly influenced the cutaneous pressure along the main superficial veins (P < 0.001). Cutaneous pressure along the short saphenous veins had better pressure gradient performance when subjects were standing. The pressures applied at the popliteal fossa and Achilles tendon were significantly influenced by body postures (P < 0.001). Insufficient pressure and reversed pressure gradients were exerted on the regions along the long saphenous veins. Flexion exercise of the joints and muscle activity of the lower limbs helped provide more support and compression on the superficial venous system.
Conclusion: Graduated compression stockings exerted significant influences on the cutaneous pressure distribution and magnitudes along the path of main superficial veins. Different testing locations and body postures induced variations on the pressure performances. Proper lower limb exercises are still recommended when wearing compression stockings.
Introduction
Chronic venous insufficiency in the lower limb is most commonly due to varicose veins, which appear as dilated, elongated, or tortuous superficial veins. Despite the considerable number of studies conducted on the etiology of varicose veins, the cause remains elusive.[1-5] However, it is generally recognized that occupation and posture are the major associated factors[1-8] and contribute significantly to the effects of raised venous pressure and incompetence of primary structures in the vein wall and valves.[9-11] People who spend most of their working day in a standing or sedentary position (eg, nursing staff, flight attendants, teachers, sales assistants) are considered to be at a high risk for varicose vein development. The development of varicose veins usually occurs in the superficial venous system of the lower limbs, especially in the long saphenous veins (LSVs) and their tributaries.[12] The short saphenous veins (SSVs) and their tributaries can also become varicose, but this occurs less often. The reported incidence of varicose veins in adults varies from 7% to 40% in men and from 14% to 51% in women.[1,6,8] If the condition cannot be prevented or treated in a timely manner, varicose veins can lead to more serious morbidities and medical complications.
Varicose veins can lead to thrombophlebitis (due to inflammation or blockage of the vein) and subsequent bleeding of the swollen veins near the skin surface.[5,12] Other complications, such as edema, skin pigmentation, varicose eczema, and venous ulceration, are mainly a result of venous hypertension.[12-15] However, the presence of varicose veins does not indicate that complications will inevitably occur. For example, 40% of limbs with ulceration caused by superficial venous incompetence do not have varicose veins.[12] The exact mechanisms that cause venous ulceration are still not fully understood; however, overlying large varicosities, low oxygen levels, and stagnant blood are considered to be possible causes.[15]
Compression therapy is an essential part of the prevention and treatment of venous diseases that affect the lower limbs. Graduated compression stockings (GCSs) provide a convenient method of maintaining pressure while allowing ambulation. Many studies have demonstrated that proper compression magnitudes and gradients can provide support to the superficial venous system and accelerate lower limb blood circulation.[16-18]
However, GCS therapy has not always been as effective in clinical practice as it has been in research studies.[19,20] In the authors’ previous study,[21] the general skin pressure distribution applied by GCSs was determined and analyzed. The authors also considered it necessary to further investigate the skin pressure at the main local regions, which would help to comprehensively understand the compression performances of GCSs and improve their medical functions. Therefore, the purpose of the present study was to examine the cutaneous pressure exerted by different graduated elastic compression stockings along the main superficial veins of the lower limb and to discuss the preventive and protective effects of compression stockings on varicose veins.
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