The purpose of this study was to compare the efficacy and safety of treating mobile iliofemoral p... more The purpose of this study was to compare the efficacy and safety of treating mobile iliofemoral patients with deep venous thrombosis (DVT) with subcutaneous lowmolecular-weight heparin (dalteparin sodium) either 200 IU/kg once-daily (group 1) or 100 IU/kg twice-daily (group 2). Methods: Consecutive patients with suspected iliofemoral DVT diagnosed by duplex ultrasonography and verified by radionuclide venography were randomized to one of the two low-molecular-weight heparin (LMWH) regimens. Perfusion and when necessary ventilation scans were performed for diagnosis of pulmonary emboli (PE) in all patients immediately after admission and were repeated after approximately 10 days, whereupon oral anticoagulation was started unless contraindicated. Minimal and maximal anti-factor Xa activity was measured after 2 to 3 days of therapy. All patients were kept mobile with compression bandages. The primary end point was reduction in frequency of PE as assessed on the second lung scan. Results: A total of 140 patients with confirmed DVT were randomized, 76 to group I and 64 to group 2. The two groups were comparable in their baseline clinical characteristics. In the initial lung scans 36 (47.4%) patients in group 1 and 29 (45.3%) patients in group 2 had objectively verified PE, but only 11 (14.5%) and 8 (12.5%) patients, respectively, had symptoms. After dalteparin treatment PE disappeared in two patients in group 1, but in two other cases new PEs occurred, (NS). In group 2 a resolution of PEs was observed in eight patients, whereas only one new PE could be detected. This change reflects the efficacy of therapy as defined by resolution of existing PEs and by the occurrence of new PEs and is statistically significant according to Mc Nemar's X 2 test with the exact binomial method pair procedure (p < 0.05). Symptomatic PE was reduced from 14.5% to 5.3% in group 1 (96% to CI for the difference,-1.5% to +17.3%) and from 12.5% to 1.6% in group 2 (95% CI for the difference 0.7% to 18 %, p < 0.05). There was one single fatal PE, one serious and three minor bleeding episodes in group 1, and one minor bleeding episode in group 2 (95% CI for the difference:-3.6% to +8.1%). Conclusions: Treatment of ambulant iliofemoral patients with DVT with 100 IU/kg dalteparin twice-daily appears to be more safe and effective than 200 IU/kg given once-daily. Bed rest is not necessary for treating mobile patients.
European Journal of Vascular and Endovascular Surgery, 2008
Objectives. The scientific quality of published clinical trials is generally poor in studies wher... more Objectives. The scientific quality of published clinical trials is generally poor in studies where compression devices have been assessed in the management of venous disease. The authors' aim was to establish a set of guidelines which could be used in the design of future clinical trials of compression treatments for venous diseases. Design. Consensus conference leading to a consensus statement. Methods. The authors form a expert consensus group known as the International Compression Club (ICC). This group obtained published medical literature in the field of compression treatment in venous disease by searching medical literature databases. The literature was studied by the group which attended a consensus meeting. A draft document was circulated to ICC members and revised until agreement between contributors was reached. Results. The authors have prepared a set of guidelines which should be given consideration when conducting studies to assess the efficacy of compression in venous disease. Conclusions. The form of compression therapy including the comparators used in the clinical study must be clearly characterised. In future studies the characteristics of the material provided by the manufacturer should be described including in vivo data on pressure and stiffness of the final compression system. The pressure exerted on the distal lower leg should be stated in mmHg and the method of pressure determination must be quoted.
Laser ablation of the great saphenous vein is a technique whose use has expanded dramatically dur... more Laser ablation of the great saphenous vein is a technique whose use has expanded dramatically during the last few years. Endovenous techniques without groin incision and high ligation are certainly less invasive than conventional vein stripping, and seem to involve less risk of neovascularization. Steven Zimmet from Austin, Texas, the immediate Past President of the American College of Phlebology, gives a well-balanced overview of laser ablation, including the mechanisms of action, technical details, results, adverse sequelae, and complications. Using tumescent anesthesia, this procedure can be performed in-office without general anesthesia or surgical incisions.
All rights reserved throughout the world and in all languages. No part of this publication may be... more All rights reserved throughout the world and in all languages. No part of this publication may be reproduced, transmitted, or stored in any form or by any means either mechanical or electronic, including photocopying, recording, or through an information storage and retrieval system, without the written permission of the copyright holder. Opinions expressed do not necessarily reflect the views of the publisher, editors, or editorial board. The authors, editors, and publisher cannot be held responsible for errors or for any consequences arising from the use of the information contained in this journal.
International angiology : a journal of the International Union of Angiology, Jun 1, 2018
Due to the evolving field of medicine, new research may, in due course, modify the recommendation... more Due to the evolving field of medicine, new research may, in due course, modify the recommendations presented in this document. At the time of publication, every attempt has been made to ensure that the information provided is up to date and accurate. It is the responsibility of the treating physician to determine the best treatment for the patient. The authors, committee members, editors, and publishers cannot be held responsible for any legal issues that may arise from the citation of this statement. Rules of evidence Management of patients with chronic venous disorders has been traditionally undertaken subjectively among physicians, often resulting in less than optimal strategies. In this document, a systematic approach has been developed with recommendations based upon cumulative evidence from the literature. Levels of evidence and grades of recommendation range from Level I and Grade A to Level III and Grade C. Level I evidence and Grade A recommendations derive from scientifically sound randomized clinical trials in which the results are clear-cut. Level II evidence and Grade B recommendations derive from clinical studies in which the results among trials often point to inconsistencies. Level III evidence and Grade C recommendations result from poorly designed trials or from small case series. 1, 2 Meta-analysis Meta-analyses are included in the present document but there should be caution as to their possible abuse. Certain studies may be included in a meta-analysis carelessly without sufficiently understanding of substantive issues, ignoring relevant variables, using heterogenous findings or interpreting results with a bias. 3 It has been demonstrated that the outcomes of 12 large randomized controlled trials were not predicted accurately 35% of the time by the meta-analyses published previously on the same topics. 4 PART I PATHOPHYSIOLOGY AND INVESTIGATION Pathophysiology Changes in superficial and deep veins Varicose veins are a common manifestation of CVD and are believed to result from abnormal dis
European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery, Jan 13, 2017
Bandage application does not exert consistent compression pressure, leading to extremely variable... more Bandage application does not exert consistent compression pressure, leading to extremely variable compression when applied to patients. A new elastic bandage can exert a predefined pressure independently of healthcare providers and the size of the wrapped limb. The bandage system includes a series of non-stretchable patches that when applied to the bandage make it stiff. The aim of this work was to assess, in an experimental setting, the venous ejection fraction (EF) from the lower leg and the tolerability of this new bandage in a group of patients affected by superficial venous incompetence. EF was measured using strain gauge plethysmography under baseline conditions and the bandage was applied with a supine pressure of 20 and 30Â mmHg, with and without the stiff patches, in 25 patients with severe venous reflux in the great saphenous vein. The interface pressure of the bandages was measured simultaneously in the medial gaiter area. All patients showed EF values that were significan...
This case report demonstrates that arterial ulcers may heal with compression therapy. The patient... more This case report demonstrates that arterial ulcers may heal with compression therapy. The patient was a 72-year-old woman with elevated blood pressure and type II diabetes mellitus, who underwent angiography because of a painful, non-healing ulcer over the shin. The angiography showed multisegment arterial occlusive disease, not amenable to surgical revascularisation. After 4 months of wearing inelastic bandages, with increased pressure over the ulcer area and hypertension and diabetes under control, the patient was pain-free and the ulcer had healed. The ankle-brachial pressure index (ABPI) increased from 0.54 at the start of treatment to 0.70. In patients with arterial leg ulcers, properly applied compression therapy using increased pressure over the wound may lead to an improvement of the arterial flow and to complete healing.
Objective Medical compression stockings are a standard, non-invasive treatment option for all ven... more Objective Medical compression stockings are a standard, non-invasive treatment option for all venous and lymphatic diseases. The aim of this consensus document is to provide up-to-date recommendations and evidence grading on the indications for treatment, based on evidence accumulated during the past decade, under the auspices of the International Compression Club. Methods A systematic literature review was conducted and, using PRISMA guidelines, 51 relevant publications were selected for an evidence-based analysis of an initial 2407 unrefined results. Key search terms included: 'acute', CEAP', 'chronic', 'compression stockings', 'compression therapy', 'lymph', 'lymphatic disease', 'vein' and 'venous disease'. Evidence extracted from the publications was graded initially by the panel members individually and then refined at the consensus meeting. Results Based on the current evidence, 25 recommendations for chronic ...
Several studies have shown an impressive reduction in swelling as a result of compression, and in... more Several studies have shown an impressive reduction in swelling as a result of compression, and inelastic bandages have become widely accepted as a part of lymphatic decongestive therapy for managing lymphoedema. Lymphoedema bandaging is indicated to reduce swelling, improve limb shape, skinand tissue-condition and to ameliorate symptoms such as discomfort. Compression therapy for lymphoedema is based mainly on the use of inelastic, short-stretch bandages with high compression, usually protecting the skin with polyurethane foam bandages. In this preliminary report it is shown that completely rigid material like zinc paste applied without padding provides a good level of efficacy.
According to the classical therapeutic concept, compression stockings are primarily used in milde... more According to the classical therapeutic concept, compression stockings are primarily used in milder forms of chronic venous insufficiency and for long-term maintenance therapy for lymphedema, while compression bandages are applied in severe stages (e.g. in venous ulcers) and for the initial decongestion therapy in lymphedema. This concept is mainly supported by the different therapeutic pressure exerted by stockings and bandages. While stockings do not exceed a pressure range of 40-50 mmHg in either body position, properly applied bandages start with a resting pressure of 50-60 mmHg, which rises by an additional 20-40 mmHg during standing or walking, depending on the stiffness of the material. The higher therapeutic pressure exerted by compression bandages explains their hemodynamic advantage, which has been demonstrated by experiments comparing the efficacy of stockings in improving the venous calf pump. In addition, in this review some practical aspects are underlined, and clinical evidence reported in the literature is discussed.
Background. In order to treat venous leg ulcers, it is recommended to use high pressure compressi... more Background. In order to treat venous leg ulcers, it is recommended to use high pressure compression (30–40 mmHg at the ankle). Compression stockings which are not operator dependant could be the best option because of their pressure control. However 30–40 mmHg compression stockings are often hard to put on. Putting two lower pressure compression stockings over each other could be a good therapeutic alternative. Objectives. To compare the in vitro pressures given by the manufacturers of 2 antiulcer kits with the in vivo interface pressures measured in healthy subjects and to evaluate the stiffness and friction indices from those kits based on the interface pressure in order to assess their clinical properties. Material and Methods. Using a Kikuhime pressure device, interface pressure was measured in 12 healthy subjects at the reference point B1. One stiffness index (Static Stiffness Index (SSI)) and a friction index have been calculated. Results. Mediven Ulcer kit gets the recommende...
Contents Foreword S3 Efficacy and reproducible compression of KTwo S4 Evidence for practice S4 Im... more Contents Foreword S3 Efficacy and reproducible compression of KTwo S4 Evidence for practice S4 Implications for clinicians S5 Aetiology S5 Sustained graduated compression therapy S7 How compression therapy works S7 Compression bandage systems S8 The static stiffness index (SSI) S8 The KTwo compression bandage system S9 Literature review S10 Alternative evidence S14 Conclusion S16 References S16
International angiology : a journal of the International Union of Angiology, 2008
The aim of this study was to review published literature concerning the use of compression treatm... more The aim of this study was to review published literature concerning the use of compression treatments in the management of venous and lymphatic diseases and establish where reliable evidence exists to justify the use of medical compression and where further research is required to address areas of uncertainty. The authors searched medical literature databases and reviewed their own collections of papers, monographs and books for papers providing information about the effects of compression and randomized clinical trials of compression devices. Papers were classified in accordance with the recommendations of the GRADE group to categorize their scientific reliability. Further classification was made according to the particular clinical problem that was addressed in the papers. The review included papers on compression stockings, bandages and intermittent pneumatic compression devices. The International Compression Club met once in Vienna and corresponded by email in order to reach an ...
Morphological studies on the effect of compression on the leg veins are rare and mostly performed... more Morphological studies on the effect of compression on the leg veins are rare and mostly performed in the supine position. The aim of this study was to investigate the influence of compression applied with different pressures on the venous calibre in the standing position. Standing magnetic resonance imaging was used to measure the venous diameters of superficial and deep leg veins in a patient with massive varicose veins without and with different levels of compression and realistic 3D vectorial models were built. In the standing position compression stockings with a pressure of 22 mmHg were able to reduce the calibre of deep calf veins, but not of superficial varices. These were compressed only by bandages exerting pressures between 51 and 83 mmHg. Compression stockings may reduce the diameter of deep calf veins in the standing position. To empty a varicose vein after venous ablation much higher pressures are required.
A review is given on the different tools of compression therapy and their mode of action. Methods... more A review is given on the different tools of compression therapy and their mode of action. Methods: Interface pressure and stiffness of compression devices, alone or in combination can be measured in vivo. Hemodynamic effects have been demonstrated by measuring venous volume and flow velocity using MRI, Duplex and radioisotopes, venous reflux and venous pumping function using plethysmography and phlebodynamometry. Oedema reduction can be measured by limb volumetry. Results: Compression stockings exerting a pressure of ~20 mmHg on the distal leg are able to increase venous blood flow velocity in the supine position and to prevent leg swelling after prolonged sitting and standing. In the upright position, an interface pressure of more than 50 mmHg is needed for intermittent occlusion of incompetent veins and for a reduction of ambulatory venous hypertension during walking. Such high intermittent interface pressure peaks exerting a "massaging effect" may rather be achieved by short stretch multilayer bandages than by elastic stockings. Conclusion: Compression is a cornerstone in the management of venous and lymphatic insufficiency. However, this treatment modality is still underestimated and deserves better understanding and improved educational programs, both for patients and medical staff.
This paper summarises the findings of a recent issue of Effective Health Care Vol 3. Leg ulcers a... more This paper summarises the findings of a recent issue of Effective Health Care Vol 3. Leg ulcers are areas of "loss of skin below the knee on the leg or foot which take more than six weeks to heal".' They are a common chronic, recurring condition which is a major cause of morbidity, suffering, and health service costs.
Conventionally, deep venous thrombosis (DVT) is treated with an intravenous infusion of unfractio... more Conventionally, deep venous thrombosis (DVT) is treated with an intravenous infusion of unfractionated heparin for at least 5 days, followed by a course of oral anticoagulants. Hospital admission and bed rest for the duration of intravenous infusions have been recommended with the goal of avoiding leg movement to protect patients from pulmonary embolism. This traditional management of DVT has changed considerably since the approval of subcutaneous administration of low molecular weight heparins (LMWHs) for the treatment of DVT. The new approach includes home treatment in selected cases. 1,2 Patients and their
Objectives: This study was conducted to define bandage pressures that are safe and effective in t... more Objectives: This study was conducted to define bandage pressures that are safe and effective in treating leg ulcers of mixed arterial-venous etiology. Methods: In 25 patients with mixed-etiology leg ulcers who received inelastic bandages applied with pressures from 20 to 30, 31 to 40, and 41 to 50 mm Hg, the following measurements were performed before and after bandage application to ensure patient safety throughout the investigation: laser Doppler fluxmetry (LDF) close to the ulcer under the bandage and at the great toe, transcutaneous oxygen pressure (TcPO 2) on the dorsum of the foot, and toe pressure. Ejection fraction (EF) of the venous pump was performed to assess efficacy on venous hemodynamics. Results: LDF values under the bandages increased by 33% (95% confidence interval [CI], 17-48; P < .01), 28% (95% CI, 12-45; P < .05), and 10% (95% CI,-7 to 28), respectively, under the three pressure ranges applied. At toe level, a significant decrease in flux of-20% (95% CI,-48 to 9; P < .05) was seen when bandage pressure >41 mm Hg. Toe pressure values and TcPO 2 showed a moderate increase, excluding a restriction to arterial perfusion induced by the bandages. Inelastic bandages were highly efficient in improving venous pumping function, increasing the reduced ejection fraction by 72% (95% CI, 50%-95%; P < .001) under pressure of 21 to 30 mm Hg and by 103% (95% CI, 70%-128%; P < .001) at 31 to 40 mm Hg. Conclusions: In patients with mixed ulceration, an ankle-brachial pressure index >0.5 and an absolute ankle pressure of >60 mm Hg, inelastic compression of up to 40 mm Hg does not impede arterial perfusion but may lead to a normalization of the highly reduced venous pumping function. Such bandages are therefore recommended in combination with walking exercises as the basic conservative management for patients with mixed leg ulcers.
The purpose of this study was to compare the efficacy and safety of treating mobile iliofemoral p... more The purpose of this study was to compare the efficacy and safety of treating mobile iliofemoral patients with deep venous thrombosis (DVT) with subcutaneous lowmolecular-weight heparin (dalteparin sodium) either 200 IU/kg once-daily (group 1) or 100 IU/kg twice-daily (group 2). Methods: Consecutive patients with suspected iliofemoral DVT diagnosed by duplex ultrasonography and verified by radionuclide venography were randomized to one of the two low-molecular-weight heparin (LMWH) regimens. Perfusion and when necessary ventilation scans were performed for diagnosis of pulmonary emboli (PE) in all patients immediately after admission and were repeated after approximately 10 days, whereupon oral anticoagulation was started unless contraindicated. Minimal and maximal anti-factor Xa activity was measured after 2 to 3 days of therapy. All patients were kept mobile with compression bandages. The primary end point was reduction in frequency of PE as assessed on the second lung scan. Results: A total of 140 patients with confirmed DVT were randomized, 76 to group I and 64 to group 2. The two groups were comparable in their baseline clinical characteristics. In the initial lung scans 36 (47.4%) patients in group 1 and 29 (45.3%) patients in group 2 had objectively verified PE, but only 11 (14.5%) and 8 (12.5%) patients, respectively, had symptoms. After dalteparin treatment PE disappeared in two patients in group 1, but in two other cases new PEs occurred, (NS). In group 2 a resolution of PEs was observed in eight patients, whereas only one new PE could be detected. This change reflects the efficacy of therapy as defined by resolution of existing PEs and by the occurrence of new PEs and is statistically significant according to Mc Nemar's X 2 test with the exact binomial method pair procedure (p < 0.05). Symptomatic PE was reduced from 14.5% to 5.3% in group 1 (96% to CI for the difference,-1.5% to +17.3%) and from 12.5% to 1.6% in group 2 (95% CI for the difference 0.7% to 18 %, p < 0.05). There was one single fatal PE, one serious and three minor bleeding episodes in group 1, and one minor bleeding episode in group 2 (95% CI for the difference:-3.6% to +8.1%). Conclusions: Treatment of ambulant iliofemoral patients with DVT with 100 IU/kg dalteparin twice-daily appears to be more safe and effective than 200 IU/kg given once-daily. Bed rest is not necessary for treating mobile patients.
European Journal of Vascular and Endovascular Surgery, 2008
Objectives. The scientific quality of published clinical trials is generally poor in studies wher... more Objectives. The scientific quality of published clinical trials is generally poor in studies where compression devices have been assessed in the management of venous disease. The authors' aim was to establish a set of guidelines which could be used in the design of future clinical trials of compression treatments for venous diseases. Design. Consensus conference leading to a consensus statement. Methods. The authors form a expert consensus group known as the International Compression Club (ICC). This group obtained published medical literature in the field of compression treatment in venous disease by searching medical literature databases. The literature was studied by the group which attended a consensus meeting. A draft document was circulated to ICC members and revised until agreement between contributors was reached. Results. The authors have prepared a set of guidelines which should be given consideration when conducting studies to assess the efficacy of compression in venous disease. Conclusions. The form of compression therapy including the comparators used in the clinical study must be clearly characterised. In future studies the characteristics of the material provided by the manufacturer should be described including in vivo data on pressure and stiffness of the final compression system. The pressure exerted on the distal lower leg should be stated in mmHg and the method of pressure determination must be quoted.
Laser ablation of the great saphenous vein is a technique whose use has expanded dramatically dur... more Laser ablation of the great saphenous vein is a technique whose use has expanded dramatically during the last few years. Endovenous techniques without groin incision and high ligation are certainly less invasive than conventional vein stripping, and seem to involve less risk of neovascularization. Steven Zimmet from Austin, Texas, the immediate Past President of the American College of Phlebology, gives a well-balanced overview of laser ablation, including the mechanisms of action, technical details, results, adverse sequelae, and complications. Using tumescent anesthesia, this procedure can be performed in-office without general anesthesia or surgical incisions.
All rights reserved throughout the world and in all languages. No part of this publication may be... more All rights reserved throughout the world and in all languages. No part of this publication may be reproduced, transmitted, or stored in any form or by any means either mechanical or electronic, including photocopying, recording, or through an information storage and retrieval system, without the written permission of the copyright holder. Opinions expressed do not necessarily reflect the views of the publisher, editors, or editorial board. The authors, editors, and publisher cannot be held responsible for errors or for any consequences arising from the use of the information contained in this journal.
International angiology : a journal of the International Union of Angiology, Jun 1, 2018
Due to the evolving field of medicine, new research may, in due course, modify the recommendation... more Due to the evolving field of medicine, new research may, in due course, modify the recommendations presented in this document. At the time of publication, every attempt has been made to ensure that the information provided is up to date and accurate. It is the responsibility of the treating physician to determine the best treatment for the patient. The authors, committee members, editors, and publishers cannot be held responsible for any legal issues that may arise from the citation of this statement. Rules of evidence Management of patients with chronic venous disorders has been traditionally undertaken subjectively among physicians, often resulting in less than optimal strategies. In this document, a systematic approach has been developed with recommendations based upon cumulative evidence from the literature. Levels of evidence and grades of recommendation range from Level I and Grade A to Level III and Grade C. Level I evidence and Grade A recommendations derive from scientifically sound randomized clinical trials in which the results are clear-cut. Level II evidence and Grade B recommendations derive from clinical studies in which the results among trials often point to inconsistencies. Level III evidence and Grade C recommendations result from poorly designed trials or from small case series. 1, 2 Meta-analysis Meta-analyses are included in the present document but there should be caution as to their possible abuse. Certain studies may be included in a meta-analysis carelessly without sufficiently understanding of substantive issues, ignoring relevant variables, using heterogenous findings or interpreting results with a bias. 3 It has been demonstrated that the outcomes of 12 large randomized controlled trials were not predicted accurately 35% of the time by the meta-analyses published previously on the same topics. 4 PART I PATHOPHYSIOLOGY AND INVESTIGATION Pathophysiology Changes in superficial and deep veins Varicose veins are a common manifestation of CVD and are believed to result from abnormal dis
European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery, Jan 13, 2017
Bandage application does not exert consistent compression pressure, leading to extremely variable... more Bandage application does not exert consistent compression pressure, leading to extremely variable compression when applied to patients. A new elastic bandage can exert a predefined pressure independently of healthcare providers and the size of the wrapped limb. The bandage system includes a series of non-stretchable patches that when applied to the bandage make it stiff. The aim of this work was to assess, in an experimental setting, the venous ejection fraction (EF) from the lower leg and the tolerability of this new bandage in a group of patients affected by superficial venous incompetence. EF was measured using strain gauge plethysmography under baseline conditions and the bandage was applied with a supine pressure of 20 and 30Â mmHg, with and without the stiff patches, in 25 patients with severe venous reflux in the great saphenous vein. The interface pressure of the bandages was measured simultaneously in the medial gaiter area. All patients showed EF values that were significan...
This case report demonstrates that arterial ulcers may heal with compression therapy. The patient... more This case report demonstrates that arterial ulcers may heal with compression therapy. The patient was a 72-year-old woman with elevated blood pressure and type II diabetes mellitus, who underwent angiography because of a painful, non-healing ulcer over the shin. The angiography showed multisegment arterial occlusive disease, not amenable to surgical revascularisation. After 4 months of wearing inelastic bandages, with increased pressure over the ulcer area and hypertension and diabetes under control, the patient was pain-free and the ulcer had healed. The ankle-brachial pressure index (ABPI) increased from 0.54 at the start of treatment to 0.70. In patients with arterial leg ulcers, properly applied compression therapy using increased pressure over the wound may lead to an improvement of the arterial flow and to complete healing.
Objective Medical compression stockings are a standard, non-invasive treatment option for all ven... more Objective Medical compression stockings are a standard, non-invasive treatment option for all venous and lymphatic diseases. The aim of this consensus document is to provide up-to-date recommendations and evidence grading on the indications for treatment, based on evidence accumulated during the past decade, under the auspices of the International Compression Club. Methods A systematic literature review was conducted and, using PRISMA guidelines, 51 relevant publications were selected for an evidence-based analysis of an initial 2407 unrefined results. Key search terms included: 'acute', CEAP', 'chronic', 'compression stockings', 'compression therapy', 'lymph', 'lymphatic disease', 'vein' and 'venous disease'. Evidence extracted from the publications was graded initially by the panel members individually and then refined at the consensus meeting. Results Based on the current evidence, 25 recommendations for chronic ...
Several studies have shown an impressive reduction in swelling as a result of compression, and in... more Several studies have shown an impressive reduction in swelling as a result of compression, and inelastic bandages have become widely accepted as a part of lymphatic decongestive therapy for managing lymphoedema. Lymphoedema bandaging is indicated to reduce swelling, improve limb shape, skinand tissue-condition and to ameliorate symptoms such as discomfort. Compression therapy for lymphoedema is based mainly on the use of inelastic, short-stretch bandages with high compression, usually protecting the skin with polyurethane foam bandages. In this preliminary report it is shown that completely rigid material like zinc paste applied without padding provides a good level of efficacy.
According to the classical therapeutic concept, compression stockings are primarily used in milde... more According to the classical therapeutic concept, compression stockings are primarily used in milder forms of chronic venous insufficiency and for long-term maintenance therapy for lymphedema, while compression bandages are applied in severe stages (e.g. in venous ulcers) and for the initial decongestion therapy in lymphedema. This concept is mainly supported by the different therapeutic pressure exerted by stockings and bandages. While stockings do not exceed a pressure range of 40-50 mmHg in either body position, properly applied bandages start with a resting pressure of 50-60 mmHg, which rises by an additional 20-40 mmHg during standing or walking, depending on the stiffness of the material. The higher therapeutic pressure exerted by compression bandages explains their hemodynamic advantage, which has been demonstrated by experiments comparing the efficacy of stockings in improving the venous calf pump. In addition, in this review some practical aspects are underlined, and clinical evidence reported in the literature is discussed.
Background. In order to treat venous leg ulcers, it is recommended to use high pressure compressi... more Background. In order to treat venous leg ulcers, it is recommended to use high pressure compression (30–40 mmHg at the ankle). Compression stockings which are not operator dependant could be the best option because of their pressure control. However 30–40 mmHg compression stockings are often hard to put on. Putting two lower pressure compression stockings over each other could be a good therapeutic alternative. Objectives. To compare the in vitro pressures given by the manufacturers of 2 antiulcer kits with the in vivo interface pressures measured in healthy subjects and to evaluate the stiffness and friction indices from those kits based on the interface pressure in order to assess their clinical properties. Material and Methods. Using a Kikuhime pressure device, interface pressure was measured in 12 healthy subjects at the reference point B1. One stiffness index (Static Stiffness Index (SSI)) and a friction index have been calculated. Results. Mediven Ulcer kit gets the recommende...
Contents Foreword S3 Efficacy and reproducible compression of KTwo S4 Evidence for practice S4 Im... more Contents Foreword S3 Efficacy and reproducible compression of KTwo S4 Evidence for practice S4 Implications for clinicians S5 Aetiology S5 Sustained graduated compression therapy S7 How compression therapy works S7 Compression bandage systems S8 The static stiffness index (SSI) S8 The KTwo compression bandage system S9 Literature review S10 Alternative evidence S14 Conclusion S16 References S16
International angiology : a journal of the International Union of Angiology, 2008
The aim of this study was to review published literature concerning the use of compression treatm... more The aim of this study was to review published literature concerning the use of compression treatments in the management of venous and lymphatic diseases and establish where reliable evidence exists to justify the use of medical compression and where further research is required to address areas of uncertainty. The authors searched medical literature databases and reviewed their own collections of papers, monographs and books for papers providing information about the effects of compression and randomized clinical trials of compression devices. Papers were classified in accordance with the recommendations of the GRADE group to categorize their scientific reliability. Further classification was made according to the particular clinical problem that was addressed in the papers. The review included papers on compression stockings, bandages and intermittent pneumatic compression devices. The International Compression Club met once in Vienna and corresponded by email in order to reach an ...
Morphological studies on the effect of compression on the leg veins are rare and mostly performed... more Morphological studies on the effect of compression on the leg veins are rare and mostly performed in the supine position. The aim of this study was to investigate the influence of compression applied with different pressures on the venous calibre in the standing position. Standing magnetic resonance imaging was used to measure the venous diameters of superficial and deep leg veins in a patient with massive varicose veins without and with different levels of compression and realistic 3D vectorial models were built. In the standing position compression stockings with a pressure of 22 mmHg were able to reduce the calibre of deep calf veins, but not of superficial varices. These were compressed only by bandages exerting pressures between 51 and 83 mmHg. Compression stockings may reduce the diameter of deep calf veins in the standing position. To empty a varicose vein after venous ablation much higher pressures are required.
A review is given on the different tools of compression therapy and their mode of action. Methods... more A review is given on the different tools of compression therapy and their mode of action. Methods: Interface pressure and stiffness of compression devices, alone or in combination can be measured in vivo. Hemodynamic effects have been demonstrated by measuring venous volume and flow velocity using MRI, Duplex and radioisotopes, venous reflux and venous pumping function using plethysmography and phlebodynamometry. Oedema reduction can be measured by limb volumetry. Results: Compression stockings exerting a pressure of ~20 mmHg on the distal leg are able to increase venous blood flow velocity in the supine position and to prevent leg swelling after prolonged sitting and standing. In the upright position, an interface pressure of more than 50 mmHg is needed for intermittent occlusion of incompetent veins and for a reduction of ambulatory venous hypertension during walking. Such high intermittent interface pressure peaks exerting a "massaging effect" may rather be achieved by short stretch multilayer bandages than by elastic stockings. Conclusion: Compression is a cornerstone in the management of venous and lymphatic insufficiency. However, this treatment modality is still underestimated and deserves better understanding and improved educational programs, both for patients and medical staff.
This paper summarises the findings of a recent issue of Effective Health Care Vol 3. Leg ulcers a... more This paper summarises the findings of a recent issue of Effective Health Care Vol 3. Leg ulcers are areas of "loss of skin below the knee on the leg or foot which take more than six weeks to heal".' They are a common chronic, recurring condition which is a major cause of morbidity, suffering, and health service costs.
Conventionally, deep venous thrombosis (DVT) is treated with an intravenous infusion of unfractio... more Conventionally, deep venous thrombosis (DVT) is treated with an intravenous infusion of unfractionated heparin for at least 5 days, followed by a course of oral anticoagulants. Hospital admission and bed rest for the duration of intravenous infusions have been recommended with the goal of avoiding leg movement to protect patients from pulmonary embolism. This traditional management of DVT has changed considerably since the approval of subcutaneous administration of low molecular weight heparins (LMWHs) for the treatment of DVT. The new approach includes home treatment in selected cases. 1,2 Patients and their
Objectives: This study was conducted to define bandage pressures that are safe and effective in t... more Objectives: This study was conducted to define bandage pressures that are safe and effective in treating leg ulcers of mixed arterial-venous etiology. Methods: In 25 patients with mixed-etiology leg ulcers who received inelastic bandages applied with pressures from 20 to 30, 31 to 40, and 41 to 50 mm Hg, the following measurements were performed before and after bandage application to ensure patient safety throughout the investigation: laser Doppler fluxmetry (LDF) close to the ulcer under the bandage and at the great toe, transcutaneous oxygen pressure (TcPO 2) on the dorsum of the foot, and toe pressure. Ejection fraction (EF) of the venous pump was performed to assess efficacy on venous hemodynamics. Results: LDF values under the bandages increased by 33% (95% confidence interval [CI], 17-48; P < .01), 28% (95% CI, 12-45; P < .05), and 10% (95% CI,-7 to 28), respectively, under the three pressure ranges applied. At toe level, a significant decrease in flux of-20% (95% CI,-48 to 9; P < .05) was seen when bandage pressure >41 mm Hg. Toe pressure values and TcPO 2 showed a moderate increase, excluding a restriction to arterial perfusion induced by the bandages. Inelastic bandages were highly efficient in improving venous pumping function, increasing the reduced ejection fraction by 72% (95% CI, 50%-95%; P < .001) under pressure of 21 to 30 mm Hg and by 103% (95% CI, 70%-128%; P < .001) at 31 to 40 mm Hg. Conclusions: In patients with mixed ulceration, an ankle-brachial pressure index >0.5 and an absolute ankle pressure of >60 mm Hg, inelastic compression of up to 40 mm Hg does not impede arterial perfusion but may lead to a normalization of the highly reduced venous pumping function. Such bandages are therefore recommended in combination with walking exercises as the basic conservative management for patients with mixed leg ulcers.
Uploads
Papers by Hugo Partsch