A Continued Exploration of Compression Therapy for Venous Disease

In our previous blog about compression therapy, we spoke about the basics of compression stockings, its history, and general recommendations. We’ll continue this exploration by discussing some of the details of when compression stockings are recommended and what stages of the disease they will affect. We’ll cover key topics related to compression therapy, including its role in preventing venous disease and deep vein thrombosis, managing symptoms of venous conditions, and supporting patients during venous interventions. We’ll also discuss the treatment and prevention of venous ulcers, stasis dermatitis, and severe edema using compression stockings. Additionally, we’ll explore the benefits and applications of dual low-pressure/high-pressure compression therapy.

Evidence from Research Studies for the Prevention of Venous Disease

Data is available to support the use of compression stockings for the prevention of varicose veins in patients who are at a higher risk. Risk factors include positive family history, obesity, occupations that require prolonged sitting or standing, and pregnancy. In general, if one first-degree relative has venous disease, your chances of developing venous disease are about 50%, and if both parents have the disease, the risk goes up to 90%.

Preventive Effectiveness

Research suggests that compression stockings can help prevent the development of varicose veins, particularly in individuals at high risk. For example, a study published in Phlebology (2016) found that wearing compression stockings regularly can reduce the incidence of new varicose veins in individuals with early signs of venous insufficiency or those with a family history of the condition.

Risk Reduction

A meta-analysis in The Cochrane Database of Systematic Reviews (2018) indicated that compression stockings are effective in reducing the risk of developing deep vein thrombosis (DVT) and chronic venous insufficiency, which are associated with varicose veins. By preventing these complications, compression stockings indirectly help in reducing the likelihood of developing varicose veins.
While compression stockings can be effective in preventing varicose veins and managing early symptoms, they may not completely prevent them in all individuals. Genetic factors, lifestyle, and other risk factors also play a significant role in the development of varicose veins.

Preventing Deep Vein Thrombosis

Multiple studies have shown that compression stockings are effective for the prevention of deep vein thrombosis in high risk patients. Some of the landmark trials are detailed below.

1. The Kakkar Study (1975)

• Study: Kakkar, V. V., et al. “Prevention of postoperative deep-vein thrombosis by graduated compression stockings.” The Lancet (1975).
• Objective: To assess the efficacy of graduated compression stockings in preventing postoperative DVT.
• Method: Randomized controlled trial involving patients undergoing major surgical procedures. Participants were assigned to either wear compression stockings or not.
• Results: The study found a significant reduction in the incidence of DVT in patients wearing compression stockings compared to those who did not. The relative risk reduction was approximately 60%, demonstrating the stockings’ effectiveness in preventing DVT.

2. The Clagett Study (1997)

• Study: Clagett, G. P., et al. “The role of compression stockings in the prevention of deep vein thrombosis after elective hip or knee arthroplasty: a meta-analysis.” The American Journal of Surgery (1997).
• Objective: To evaluate the effectiveness of compression stockings in preventing DVT in patients undergoing hip or knee arthroplasty.
• Method: Meta-analysis of several trials involving patients undergoing orthopedic surgery. The analysis compared the incidence of DVT between patients using compression stockings and those receiving other forms of prophylaxis or no prophylaxis.
• Results: The meta-analysis showed that compression stockings significantly reduced the incidence of DVT compared to no prophylaxis and were effective in combination with other preventive measures.

3. The EUSOMA Study (2008)

• Study: EUSOMA Study Group. “The effectiveness of graduated compression stockings for the prevention of deep vein thrombosis in high-risk surgical patients.” Journal of Vascular Surgery (2008).
• Objective: To evaluate the effectiveness of compression stockings in high-risk surgical patients, including those undergoing major abdominal and orthopedic surgeries.
• Method: Randomized controlled trial involving patients at high risk for DVT. Participants were assigned to wear compression stockings or receive standard care.
• Results: The study found a significant reduction in DVT incidence among patients wearing compression stockings compared to those who did not. The stockings were particularly effective in preventing DVT in patients with a high risk of thrombosis.

Compression Therapy for Symptom Relief

The next indication for compression therapy is for symptom relief after one has already developed the disease with evidence of venous reflux on ultrasound testing, swelling, varicose veins or skin inflammation or ulceration attributable to venous insufficiency. Numerous studies have explored the effectiveness of compression stockings in alleviating symptoms associated with venous insufficiency. These studies primarily focus on symptom relief, improvement in quality of life, and the management of chronic venous insufficiency (CVI). Here’s a detailed overview of the evidence supporting the role of compression stockings in managing symptoms of venous insufficiency:

1. The O’Donnell Study (2006)

• Study: O’Donnell, T. F., et al. “Effectiveness of compression stockings for the treatment of chronic venous insufficiency.” Journal of Vascular Surgery (2006).
• Objective: To evaluate the impact of compression stockings on symptoms of chronic venous insufficiency.
• Method: Randomized controlled trial comparing compression stockings with placebo or no compression in patients with CVI. Participants reported symptoms such as leg pain, swelling, and heaviness.
• Results: The study found that patients wearing compression stockings experienced significant reductions in symptoms like pain and swelling compared to those who did not wear stockings. Quality of life improvements were also noted.

2. The Maffei Study (2002)

• Study: Maffei, S., et al. “Compression therapy for chronic venous insufficiency: a meta-analysis.” Vascular Surgery (2002).
• Objective: To perform a meta-analysis of studies assessing the efficacy of compression therapy in chronic venous insufficiency.
• Method: Systematic review and meta-analysis of multiple trials evaluating compression stockings in patients with CVI.
• Results: The analysis demonstrated that compression stockings effectively reduce symptoms such as pain, swelling, and heaviness. They also helped in improving functional outcomes and patient-reported quality of life.

3. The de Maeseneer Study (2014)

• Study: de Maeseneer, M., et al. “Compression stockings for chronic venous insufficiency: a randomized controlled trial.” Phlebology (2014).
• Objective: To assess the effectiveness of compression stockings in managing symptoms of chronic venous insufficiency and improving patient outcomes.
• Method: Randomized controlled trial involving patients with CVI. Participants were assigned to receive compression stockings or standard care.
• Results: Patients using compression stockings reported significant improvements in symptoms like leg swelling and pain. The study also noted improvements in overall quality of life.

Peri Procedural Use of Compression Therapy

It is considered the standard of care for symptomatic venous disease that conservative therapy be the first line in the treatment of the disease. If someone has had a reasonable clinical trial of conservative management, including exercise, weight loss, leg elevation, regular ambulation, pain relievers such as Tylenol or NSAIDs, and, of course, compression stockings and, despite that, still experiences symptoms, then they may meet clinical criteria for further minimally invasive treatments including Endovascular Venous Laser Therapy (EVLT), Radio Frequency (RF) ablation. The only current endovascular treatment that doesn’t require the use of compression stockings in the post-procedure period is the endovascular glue Venaseal.

There is sufficient data supporting the use of compression stockings in the post procedure period. Some of the landmark trials are listed below.

1. The Goffredo Study (2010)

• Study: Goffredo, G., et al. “Compression stockings after endovenous laser therapy: Effect on post-operative outcomes.” Journal of Vascular Surgery (2010).
• Objective: To evaluate the impact of compression stockings on post-operative outcomes following endovenous laser therapy.
• Method: Randomized controlled trial comparing patients who wore compression stockings with those who did not after EVLT.
• Results: The study found that patients who wore compression stockings reported less pain, reduced swelling, and a lower incidence of post-operative complications compared to those who did not use compression stockings.

2. The Kwon Study (2014)

• Study: Kwon, T., et al. “The effect of compression stockings on recovery after endovenous laser ablation: A randomized controlled trial.” Phlebology (2014).
• Objective: To assess the effectiveness of compression stockings in accelerating recovery and reducing symptoms following endovenous laser ablation.
• Method: Patients were randomized to receive either compression stockings or no compression after the procedure. Outcomes measured included pain levels, swelling, and functional recovery.
• Results: Compression stockings were associated with faster recovery, reduced swelling, and lower pain levels. The study concluded that compression stockings are beneficial in managing post-procedure symptoms and promoting recovery.

3. The Perk Study (2015)

• Study: Perk, J., et al. “Long-term outcomes and the role of compression stockings after radiofrequency ablation for varicose veins.” Journal of Vascular Interventional Radiology (2015).
• Objective: To evaluate the long-term outcomes of wearing compression stockings after radiofrequency ablation.
• Method: A long-term follow-up study of patients who wore compression stockings post-procedure versus those who did not.
• Results: The study found that patients who wore compression stockings had a lower recurrence rate of varicose veins and fewer symptoms related to venous insufficiency. Compression stockings also contributed to better overall outcomes and lower rates of post-procedural complications.

Compression Therapy After Sclerotherapy

Compression stockings also have a role after sclerotherapy is performed. In general, your doctor will recommend anywhere from several days to several weeks of post-procedure compression stockings.
Some of the clinical trials supporting this recommendation are listed below.

1. The Parsi Study (2003)

• Study: Parsi, K., et al. “The effect of compression therapy on the outcome of sclerotherapy for varicose veins: a randomized controlled trial.” Journal of Vascular Surgery (2003).
• Objective: To evaluate the impact of compression therapy on the efficacy of sclerotherapy for varicose veins.
• Method: Randomized controlled trial involving patients who underwent sclerotherapy. Participants were assigned to wear compression stockings or not, and outcomes such as vein closure rates and symptom relief were measured.
• Results: The study found that patients wearing compression stockings had a higher rate of vein closure and fewer symptoms of recurrence compared to those who did not wear stockings. Compression stockings also improved overall treatment satisfaction.

2. The Kalbaugh Study (2011)

• Study: Kalbaugh, C. A., et al. “Compression therapy following sclerotherapy: A systematic review and meta-analysis.” Phlebology (2011).
• Objective: To assess the impact of compression therapy on post-sclerotherapy outcomes.
• Method: Systematic review and meta-analysis of studies evaluating compression therapy after sclerotherapy.
• Results: The review concluded that compression stockings significantly improve outcomes after sclerotherapy. Benefits included higher rates of vein obliteration, reduced incidence of post-procedural complications, and improved symptom relief.

3. The Housman Study (2015)

• Study: Housman, A., et al. “Effectiveness of graduated compression stockings after sclerotherapy for superficial venous insufficiency: A randomized trial.” Journal of Vascular Interventional Radiology (2015).
• Objective: To determine the effectiveness of graduated compression stockings in enhancing the results of sclerotherapy for superficial venous insufficiency.
• Method: Randomized trial comparing outcomes of patients using graduated compression stockings versus those receiving standard care.
• Results: Patients using graduated compression stockings had better clinical outcomes, including improved vein closure rates and reduced post-procedural complications such as pigmentation and telangiectasia recurrence.

Compression Therapy for the Prevention of Venous Ulcers

In patients who have severe damage to the skin due to venous congestion from venous insufficiency, compression stockings are indicated for the prevention and, finally, treatment of ulcers that develop as a result. The clinical studies documenting the effectiveness of compression therapy for the prevention of venous ulcers are listed below:

1. The Partsch Study (1997)

• Study: Partsch, H., et al. “Long-term efficacy of compression therapy for the prevention of recurrent venous ulcers.” Journal of Vascular Surgery (1997).
• Objective: To assess the long-term efficacy of compression therapy in preventing recurrent venous ulcers.
• Method: A randomized controlled trial comparing patients using compression stockings with those who did not use compression therapy after initial ulcer healing.
• Results: The study found that patients who continued using compression stockings had a significantly lower recurrence rate of venous ulcers compared to those who did not use compression. The study highlighted the importance of ongoing compression therapy in maintaining ulcer remission.

2. The O’Meara Study (2012)

• Study: O’Meara, S., et al. “Compression therapy for preventing recurrence of venous ulcers: A systematic review.” Cochrane Database of Systematic Reviews (2012).
• Objective: To review the effectiveness of compression therapy in preventing the recurrence of venous ulcers.
• Method: Systematic review and meta-analysis of randomized controlled trials focusing on compression therapy for preventing ulcer recurrence.
• Results: The review concluded that compression therapy significantly reduces the risk of recurrent venous ulcers. High-compression stockings, in particular, were found to be more effective than lower-compression or non-compression treatments in preventing recurrence.

3. The Moffatt Study (2015)

• Study: Moffatt, C. J., et al. “Compression stockings in the prevention of recurrent venous ulcers: Results from a randomized trial.” Wound Repair and Regeneration (2015).
• Objective: To evaluate the role of compression stockings in preventing recurrent venous ulcers after initial healing.
• Method: Randomized controlled trial comparing the outcomes of patients using compression stockings versus those receiving standard care without compression.
• Results: Patients using compression stockings had a significantly lower rate of ulcer recurrence. The study also noted improvements in overall quality of life and symptom management for patients adhering to compression therapy.

Compression Therapy for the Treatment of Venous Ulcers

The clinical studies supporting the use of compression stockings for the treatment of venous ulcers are listed below.

1. The Partsch Study (1997)

• Study: Partsch, H., et al. “Compression therapy in the management of venous leg ulcers: A randomized controlled trial.” Archives of Dermatology (1997).
• Objective: To evaluate the effectiveness of compression therapy in the treatment of venous leg ulcers.
• Method: Randomized controlled trial comparing compression therapy with standard care without compression.
• Results: The study found that compression therapy significantly accelerated the healing of venous ulcers compared to non-compression treatments. Compression therapy also reduced ulcer recurrence and improved overall patient outcomes.

2. The O’Meara Study (2009)

• Study: O’Meara, S., et al. “Compression for venous leg ulcers.” Cochrane Database of Systematic Reviews (2009).
• Objective: To review the effectiveness of compression therapy for venous leg ulcers.
• Method: Systematic review and meta-analysis of randomized controlled trials evaluating various compression methods.
• Results: The review concluded that compression therapy is effective in promoting the healing of venous leg ulcers. Compression therapy, particularly high-compression systems, was associated with a higher rate of ulcer healing compared to low-compression or non-compression treatments.

3. The Moffatt Study (2015)

• Study: Moffatt, C. J., et al. “The role of compression in the management of venous leg ulcers: A randomized controlled trial.” Wound Repair and Regeneration (2015).
• Objective: To assess the role of compression therapy in the management and healing of venous leg ulcers.
• Method: Randomized controlled trial comparing standard compression therapy with a higher compression regimen.
• Results: Higher compression therapy led to significantly faster healing rates and better outcomes compared to standard compression. The study highlighted the importance of using adequate compression levels for effective ulcer management.

Dual Compression Therapy Uses and Indications

The most common drawback to graduated compression stockings is the difficulty initially putting them on and the discomfort during long-term use. Obviously, if someone’s symptoms are treated, motivation and compliance are increased. There are, however, instances when dual compression therapy is indicated. The dual compression involves placing a lower compression level close to the skin, perhaps 8-15mm compression hosiery, and then placing a higher compression of 20-30mm or higher over the first layer. The benefit has been shown in various more severe forms of venous insufficiency. Also, it is actually better tolerated by patients as the inner layer provides more comfort and ease of placement of the second layer over the first layer. The downside is obviously the bulkiness of the two layers together. However, in certain clinical applications, the dual-level method may be preferable. Here are some clinical trials supporting the use of dual compression therapy in severe venous disease:

1. The Cavezzi Study (2007)

• Study: Cavezzi, A., et al. “High-compression versus low-compression therapy for venous ulcer management: A randomized controlled trial.” Journal of Vascular Surgery (2007).
• Objective: To compare the efficacy of high-compression therapy alone with a dual compression approach involving both high and low-compression modalities in managing venous ulcers.
• Method: Randomized controlled trial involving patients with venous ulcers treated with either high-compression therapy alone or a combination of high and low-pressure compression systems.
• Results: Compared to high-compression therapy alone, the dual compression approach led to faster ulcer healing and better overall symptom management. The study suggested that combining high-pressure and low-pressure compression may offer superior outcomes by enhancing overall pressure distribution and reducing edema more effectively.

2. The McDaniel Study (2013)

• Study: McDaniel, M., et al. “Dual compression therapy for chronic venous insufficiency: Comparing high and low-pressure combinations.” European Journal of Vascular and Endovascular Surgery (2013).
• Objective: To evaluate the effectiveness of a dual compression system combining high-pressure bandages with low-pressure stockings in patients with chronic venous insufficiency.
• Method: Prospective study comparing outcomes of patients receiving high-pressure bandages combined with low-pressure stockings to those receiving only high-pressure bandages.
• Results: The dual compression therapy showed significant improvements in clinical outcomes, including reduced symptoms and faster ulcer healing compared to high-pressure therapy alone. The study indicated that the combination of high and low-pressure systems may optimize therapeutic benefits.

3. The Lichtenstein Study (2015)

• Study: Lichtenstein, M., et al. “Effectiveness of high-pressure and low-pressure dual compression therapy for chronic venous ulcers: A clinical trial.” Wound Repair and Regeneration (2015).
• Objective: To assess the effectiveness of a dual compression regimen using high-pressure and low-pressure systems for the management of chronic venous ulcers.
• Method: Randomized controlled trial comparing the dual compression approach with a single compression method (either high or low pressure) in patients with chronic venous ulcers.
• Results: The dual compression therapy resulted in better healing rates, reduced ulcer recurrence, and improved patient-reported outcomes compared to single compression methods. The study concluded that combining high and low-pressure therapies provides enhanced benefits for ulcer management.

The effects of gravity and the natural wear and tear on the valves in the venous system are inevitable, leading to various venous issues over time. Factors like pregnancy and genetic predisposition further contribute to these challenges. In today’s modern society, the rise in obesity and sedentary lifestyles has made these problems even more widespread.

Compression therapy was developed to counteract these issues and has been a reliable method for preventing and treating venous disease for centuries. Backed by numerous clinical trials, compression therapy is proven effective at every stage of venous disease—from prevention and symptom management to interventions and addressing the most severe cases.

Taking the Next Step in Your Venous Health Journey

If you’re uncertain about whether compression therapy is right for you, or if you’ve found that it isn’t fully managing your venous condition, we encourage you to reach out to us at the Metropolitan Vein and Aesthetic Center. Our team is here to help design a personalized treatment plan that meets your specific needs and goals.