Indications and contraindications of compression stockings

Even though graduated compression stockings are the non-invasive therapeutic pillar of venous and lymphatic diseases, there is never enough talk when it comes to when to use them and when not to use them. In this post we will see when compression stockings are indicated, when they are suggested and when we do NOT recommend them.

“Our head is round to allow thoughts to change direction”

Who should wear compression stockings

It is known that those suffering from venous insufficiency or lymphatic disorders will probably have to use elastocompression for several years and in some cases the rest of their life.

Indications

The indications for the use of stockings vary from person to person, it is difficult to establish general dogmas that at some point, individually, we should not rethink. Fortunately, there is a lot of experience in this regard because it is a widely practiced and documented non-invasive treatment option. Many experts have worked on it and have developed guidelines for clinical practice on which we rely.

Given these “circumstantial” events, we will be able to understand why a doctor’s regular check-ups are necessary to make the necessary adjustments each time one of these circumstances arrives, thus bringing the patient’s treatment to fruition.

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Let’s see some of the most accepted indications of elastocompression by means of decreasing graduated compression stockings:

INDICATIONS OF THE COMPRESSIVE STOCKINGS

  • When there are characteristic venous symptoms in the legs of people with chronic venous insufficiency (CVI) such as pain, heaviness, tension, changes in color, cramps without any other explanation, etc. Thereby bringing to attention the possible improvement in quality of life for those who present these symptoms and edema (save for massive edema).
  • The use of compression stockings has also been recommended in healthy individuals at risk of leg swelling due to immobility (for example, during long flights) or when edema is associated with occupational factors that leads to standing or sitting for a long time (Hairdressers, surgeons, etc).
  •  Its use is suggested when reducing pathological changes in the skin of the legs in patients with CVI (redness, sclerosis, spots, atrophy, etc.) is needed.
  • For the treatment of varicose ulcer, facilitating its healing, reducing the pain associated with them and preventing their recurrence.
  • For the initial post-surgical treatment of varicose veins. Not all patients return to the asymptomatic clinical class after venous interventions, even if their condition has improved, so they may still require treatment with stockings.
  • The use of compression stockings after liquid vein sclerotherapy is suggested to achieve better results.
  • They are indicated in the management of Lymphedema, during the maintenance phase of treatment compression stockings are considered perhaps the most important intervention.
  • Patients with deep or superficial vein thrombosis: Immediate compression has been recommended in these cases to reduce pain and swelling, thus allowing mobilization in acute thrombosis. In addition, its use as soon as possible helps prevent the development of post thrombotic syndrome.
  • Compression stockings are indicated in patients with post-thrombotic syndrome (PTS) already onset.
  • In patients undergoing major surgery as a basic component of mechanical prophylaxis to prevent thrombosis.
  • Compression stockings should be considered in situations requiring thrombosis prevention (thromboprophylaxis) when anticoagulants are contraindicated.

The stockings are equally beneficial for all ages, although older patients wear them more frequently since they tend to suffer more from vascular problems, with the observation that they should be monitored so that they do not compromise arterial circulation.

Other cases where we may consider wearing compression stockings or consulting a doctor about it

Let’s see below several cases where we have seen the use of these compression devices several times and even when they are not part of the formal indications, your doctor may suggest using them based on his experience:

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SUGGESTIONS FOR USE

  • Legs with an inflammatory condition that are chronically swollen, painful, or fatigued.
  • Known risk of blood clots, especially in the legs.
  • Family or personal history of deep vein thrombosis.
  • When long periods of immobility or long bed rests are expected, especially in convalescence, use low degrees of compression.
  • In sports medicine there is an increasing demand for graduated compression stockings for athletes who want to optimize their recovery times.
  • They can help reduce swelling and leg discomfort during pregnancy.

Contraindications to the use of compression stockings

Stockings are generally safe to wear, with relatively few complications. Poorly fitting stockings (wrinkled or folded) can cause discomfort and, on worst case scenarios, pressure-induced necrosis.

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There are certain conditions where stockings are contraindicated by the opinions of the experts exposed in the clinical practice guidelines:

CONTRAINDICATIONS OF THE USE OF COMPRESSIVE STOCKINGS

  • Severe peripheral neuropathy or other cause of sensory disability.
  • Patients who cannot communicate.
  • Patients who cannot remove their stockings in case of pain.
  • Severe deformation of the limb.
  • Allergy to the manufacturing material.
  • Massive leg edema or pulmonary edema due to congestive heart failure.
  • Local condition of the skin or soft tissues, including recent skin graft, fragile “tissue paper” skin, gangrene, suppurating dermatitis, severe cellulitis, strongly exuding ulcers, cutaneous sepsis.
  • Arterial insufficiency: signs of ischemia with ankle / arm index <0.7, systolic ankle pressure less than 70 mmHg, signs of intermittent claudication, or after a bypass graft (“bypass” or arterial bridge) in the limb.

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Bibliographic References

Alam M, Silapunt S. Procedures in Cosmetic Dermatology Series: Treatment of Leg Veins E-Book. Elsevier Health Sciences; 2010.

Lim CS, Davies AH. Graduated compression stockings. CMAJ. 2014;186(10):E391-E398. doi:10.1503/cmaj.131281

Rabe E, Partsch H, Hafner J, et al. Indications for medical compression stockings in venous and lymphatic disorders: An evidence-based consensus statement. Phlebology. 2018;33(3):163-184. doi:10.1177/0268355516689631

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