Do you have varicose veins? If yes, don’t fret because thirty percent of the adult population in developed countries is affected by varicose veins. (1)
It may be a cosmetic problem for you but for others, it may stem from an underlying disease.
But what do you think is a good way to treat varicose veins?
Studies show that conservative treatment is still the best way to go in treating varicose veins. Compression therapy is the first-line treatment for varicose veins. (2) In this article, we will be discussing varicose veins and the best compression stockings to invest in!
Varicose veins mostly develop as it is the early manifestation of chronic venous insufficiency. Normally, veins are not much visible under our skin, but when we start to develop varicose veins, it becomes more and more visible. These are seen as bluish to purple widened and tortuous veins found mostly in the lower extremities.
In cases where there is an absence of chronic venous insufficiency and varicose vein still develops, genetics is mostly the cause of the pathology. Genetics also play a large role in the development of varicose veins. Most patients develop varicose veins because of vein wall weakness.
The prevalence of varicose veins is higher in industrialized countries. Globally, 10-30% of the population is affected by lower limb varicose veins. (3) There is a twofold to threefold predominance in women than in men. (4)
What are the Signs and Symptoms of Varicose Veins?
We need to recognize varicose veins to know when to start treatment!
Initially, it may pose a cosmetic problem but in cases where it is secondary to chronic insufficiency, it may progress into a more severe disease entity. What do we look for in the diagnosis of varicose veins?
- Bluish to purple appearance of veins in the lower limbs
- Tortuous, bumpy, and bulging texture of veins
- Spider veins may also be seen
- Changes in the skin around the veins. This may be seen as a thickening or discoloration.
- Swelling of the lower limbs
- Presence of venous ulcers, or open lesions
Initially, varicose veins may not present with symptoms. In a progressing disease, symptoms of varicose veins may include:
- Itching of the lower limbs
- Heaviness on the legs
- Throbbing and burning of the swollen legs
- Worsened pain in the lower limbs after prolonged sitting and standing
- Bleeding from the varicose veins
Proper and accurate diagnosis of varicose veins and venous insufficiency is vital as it would dictate the correct treatment needed for the patient. You must disclose your medical history and the symptoms you are feeling to your doctors!
What are the Treatments for Varicose Veins?
In developed countries, treatment is often sought for when varicose veins are cosmetically unpleasing. For most of us, we only look for treatment when symptoms arise. Conservative treatment involves the use of compression therapy.
Other treatments in varicose veins include the following:
- Endothermal ablation
- Radiofrequency ablation
- Endovenous laser treatment
- Ultrasound-guided Foam Sclerotherapy
- Surgical procedures
- High ligation and stripping
- Ambulatory phlebectomy
- Transilluminated powered phlebectomy
- Cyanoacrylate glue occlusion
What is Compression Therapy?
Compression therapy is the gold standard for the treatment of varicose veins. It is also used in other conditions such as lymphatic insufficiency in the lower limbs, deep vein thrombosis, and post-thrombotic syndrome. (5) It is a standard, non-invasive treatment that is easily available for those who do not want surgical interventions. Many forms of compression therapies are available. It includes elastic and non-elastic bandages, boots, hosiery, or stockings. (5)
How Does Compression Stockings Work?
Compression stockings work by exerting external pressure on the lower extremities. The greatest pressure is often at the ankles then gradually decreasing upwards. (5) This pressure gradient makes sure that the blood does not reflux downwards. Unlike arteries, veins are compressible. The compression made by the stockings, decreases the diameter of the veins, subsequently increasing the velocity and volume of blood flow. (6) Inflammation is also reduced in compression stockings use but the mechanism behind this is still unknown. (5) Compression stockings also relieve pain, heaviness, and swelling of the lower limbs.
Compression stockings help lower venous pressure, decrease venous stasis and inflammation, and enhance tissue vascularization. (7) Proper pressure is needed to achieve results from compression therapy. This is determined by your doctor.
What are Types of Compression Stockings?
There are different types of compression stockings available and it is only proper to use the best compression stockings needed for your condition.
Graduated or medical compression stockings
Graduated compression stockings are specially made stockings that squeeze the legs. It is available in pharmacies and medical supply companies. Medical compression stockings are available in different types and with different pressures.
Graduated compression stockings maybe knee high or thigh high. It can also be classified according to the material used and whether it is elastic or inelastic. There is no standardized pressure made for compression stockings as it is dependent on the manufacturers. Generally, the following are the classification of the pressure gradient. (8)
|Class||Types of Compression||Pressure|
|Support||Mild Compression||8-15 mmHg|
|Class 1||Moderate Compression||15-20 mmHg|
|Class 2||Strong Compression||20-30 mmHg|
|Class 3||Very Strong Compression||30-40 mmHg|
Mild compression stockings are the lightest compression stockings. It is best for the maintenance of healthy legs. It also provides relief for those with painful and crampy legs especially in prolonged standing or sitting after work. Small swelling is often controlled by mild compression stockings. Those who have long flights are advised to use mild compression stockings. This type of compression stockings is often available over the counter and it does not require a prescription.
Class 1 or moderate compression stockings are the first medical-grade compression stockings. It is most frequently prescribed by doctors in mild diseases. Circulation is enhanced with the use of mild compression stockings. Small swelling can be controlled even in pregnant women. Class 1 is used in the prevention of deep vein thrombosis. Those who engage in sports are also prescribed with this class of compression stockings.
Class 2 or strong compression are stockings used in mild to moderate edema, varicose veins, and deep vein thrombosis. Varicose veins, edema, deep vein thrombosis, and those who are post-surgery and post-sclerotherapy often use this degree of compression. It heals active venous ulcers.
Class 3 compression stockings are the highest level of compression available. It is only used when prescribed by doctors. Serious venous diseases are indicated for class 3 compression stockings. Post-thrombotic syndromes are also indicated for this degree of compression. This also helps reduce symptoms of orthostatic hypotension and postural hypotension. Deep vein thrombosis is also prevented by using class 3 compression stockings.
Factors that influence the overall pressure include the elasticity and stiffness of the stocking materials, shape and size of the patient’s legs, and the movements and activities performed by the patient. (5) It also helps in the management of venous ulcers and manifestations of post-thrombotic syndrome
These types of compression stockings are recommended for patients with varicose veins, and chronic venous insufficiency. This is also designed for ambulatory patients.
Similar to the graduated compression stockings, anti-embolism stockings also provide graduated compression. (5) These are used to prevent deep vein thrombosis. It increases blood flow velocity and promotes venous return. (9) Anti-embolism stockings are also available in thigh length and knee-length. Anti-embolism stockings are used in bedridden patients.
Non Medical support hosiery
Flight socks and elastic support stockings are classified under nonmedical support hosiery. (5) This type of socks is used to support the legs in prolonged standing like teachers, flight stewardess, and nurses. The compression exerted by nonmedical support hosiery is less than the graduated compression stockings. Compression is nongraduated and uniform all over. They are available in stores and over the counter.
When do you Need Compression Therapy?
Compression stockings are indicated in the following:
Compression stockings are the mainstay of treatment in varicose veins with symptoms. Symptoms of varicose veins are relieved by compression therapy. It improves the circulation of the lower extremities, reducing blood stasis. It is used alone or in conjunction with a surgical procedure such as sclerotherapy. It has been shown to reduce the formation of thrombi and prevents skin discoloration and matting by minimizing angiogenesis and inflammation. (5)
Chronic Venous Insufficiency
Chronic venous insufficiency is one indication for use of compression stockings. The use of compression stockings in chronic venous insufficiency improves skin changes such as eczema, induration, and lipodermatosclerosis. (10) High-pressure compression also reduces the recurrence of venous ulcers.
Acute Stage of Deep Vein Thrombosis
Deep vein thrombosis prevention is one of the uses of compression stockings. Reduced deep vein thrombosis incidence is noted in patients using compression stockings as compared to those who do not. The use of compression therapy is effective when used with effective anticoagulant therapy. (5)
Other indications for compression stockings are:
- Lymphatic Disorders (Lymphedema)
- Edema in cellulitis, vasculitis, and other systemic medical treatments
Contraindications of Compression Therapy
Patients suffering from the following conditions are not advised to use compression stockings:
- Severe congestive heart failure (Pulmonary edema, and severe leg edema)
- Severe leg edema
- Critical limb ischemia
- Peripheral neuropathy or other sensory impairment
- Extreme deformity of the leg, or unusual leg shape
- Conditions with fragile tissue paper skin over bony prominences
- Patients with allergies to the stocking material
What are the Complications of Compression Stockings?
Complications of compression stockings are preventable. (5) Proper assessment, measurement, and fitting are important for the prevention of allergic reactions and skin necrosis. If complications occur, it is best to consult with your doctor and change the materials and reduce the compression pressure.
How to Effectively Use Compression Stockings?
Compliance is also an important factor in the outcome of compression stockings use. A non-compliance rate of 30-65% is reported in patients prescribed to wear compression stockings. (5) Reasons for discontinuation of compression stockings include high cost, sweating, itching, cosmetic reason, edema exacerbation, exudation lesions of lower legs, and application difficulty. (11) Proper fitting, suitable stocking material, and an appropriate degree of compression improve compliance of patients.
Proper measurement of the legs is needed in determining the compression stockings for you. Ankle measurement is taken at the narrowest diameter above the ankle bone. The calf is also measured specifically on the widest part. Calf length is measured while on sitting position with the legs at a 50-degree angle from the knee joint.
Tips on how to wear your compression stockings properly:
- Before putting them on, make sure that it is hand-washed since this would make them more flexible and easier to maneuver.
- If you have an open wound, make sure to dress it properly.
- The best time to wear your stockings is after your morning bath.
- Make sure that your legs are dry.
- Sit in a chair with a back so that you can lean on when you put on the stockings. Grasp the top of the stocking with one hand and reach inside towards the toe part with your other hand. Roll it inside out to easily wear the stockings without damaging it by stretching it too much. Slowly roll and slide the stockings into your heel and gradually pull it upwards.
- Do not hurry when putting on your stockings as it will be more difficult for you.
In summary, we have discussed the following:
- What are the Signs and Symptoms of Varicose Veins?
- What are the Treatments for Varicose Veins?
- What is Compression Therapy?
- How Does Compression Stockings Work?
- What are Types of Compression Stockings?
- When do you Need Compression Therapy?
- Contraindications of Compression Therapy
- What are the Complications of Compression Stockings?
- How to Effectively Use Compression Stockings?
Compression stockings are still the first-line treatment for varicose veins as it increases venous blood flow, decreases blood volume, reduces reflux, and venous hypertension.
It also reduces inflammation and edema. Proper discussion with your doctor is needed to understand the benefits and risks of using compression stockings.
Measurements and the degree of compression are also dependent on the severity of your varicose veins. Severe symptoms and diseases require a stronger degree of compression. Commitment to using compression stockings is also vital as it is not a comfortable task.
Ready to get those compression stockings?
Consult your doctor before you buy the compression stockings best for you! You can contact us here!
- Shadrina, A.S., Sharapov, S.Z., Shashkova, T.I., & Tsepilove, Y.A. (2019). Varicose veins of lower extremities: Insights from the first large-scale genetic study. PLOS Genetics 15(4). https://doi.org/10.1371/journal.pgen.1008110
- National Clinical Guideline Centre (UK). (2013). Varicose Veins in the Legs: The Diagnosis and Management of Varicose Veins. London: National Institute for Health and Care Excellence (UK); (NICE Clinical Guidelines, No. 168.) 8, Conservative Management. Available from: https://www.ncbi.nlm.nih.gov/books/NBK328015/
- Yun, M. J., Kim, Y. K., Kang, D. M., Kim, J. E., Ha, W. C., Jung, K. Y., & Choi, H. W. (2018). A Study on Prevalence and Risk Factors for Varicose Veins in Nurses at a University Hospital. Safety and health at work, 9(1), 79–83. https://doi.org/10.1016/j.shaw.2017.08.005
- Chen, J.C. (2017). Current therapy for primary varicose veins. BCMJ, 59(8), 418-423.
- Lim, C. S., & Davies, A. H. (2014). Graduated compression stockings. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne, 186(10), E391–E398. https://doi.org/10.1503/cmaj.131281
- Motykie, G. D., Caprini, J. A., Arcelus, J. I., Reyna, J. J., Overom, E., & Mokhtee, D. (1999). Evaluation of therapeutic compression stockings in the treatment of chronic venous insufficiency. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.], 25(2), 116–120. https://doi.org/10.1046/j.1524-4725.1999.08095.x
- Health Quality Ontario (2019). Compression Stockings for the Prevention of Venous Leg Ulcer Recurrence: A Health Technology Assessment. Ontario health technology assessment series, 19(2), 1–86.
- Partsch, H., et al. (2008). Classification of Compression Bandages: Practical Aspects. Dermatologic surgery : official publication for American Society for Dermatologic Surgery, 34, 600-609. https://doi.org/10.1111/j.1524-4725.2007.34116.x
- Wade, R., Paton, F., Rice, S., Stansby, G., Millner, P., Flavell, H., Fox, D., & Woolacott, N. (2016). Thigh length versus knee length antiembolism stockings for the prevention of deep vein thrombosis in postoperative surgical patients; a systematic review and network meta-analysis. BMJ open, 6(2), e009456. https://doi.org/10.1136/bmjopen-2015-009456
- Rabe, E., Partsch, H., Hafner, J., Lattimer, C., Mosti, G., Neumann, M., Urbanek, T., Huebner, M., Gaillard, S., & Carpentier, P. (2018). Indications for medical compression stockings in venous and lymphatic disorders: An evidence-based consensus statement. Phlebology, 33(3), 163–184. https://doi.org/10.1177/0268355516689631
- Ziaja, D., Kocełak, P., Chudek, J., & Ziaja, K. (2011). Compliance with compression stockings in patients with chronic venous disorders. Phlebology, 26(8), 353–360. https://doi.org/10.1258/phleb.2010.010086
Dr. Nima Azarbehi
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