As we have already mentioned in the previous post, therapeutic compression is the most effective way to treat ambulatory venous hypertension and its consequences, such as the aggravation of chronic venous insufficiency that causes edema or ulcer in more advanced stages.
To achieve the goal of reducing venous hypertension, we can do it with different products or systems with which to perform efficient compression.
Next, we are going to see some of these systems and what their field of application would be. We will talk about 4 basic systems: phlebological compression bandages, graduated compression stockings, medical grade, adaptive compression systems also known as adjustable velcro systems and intermittent compression systems.
Phlebological Compression Bandage (VCF) and Multiple Component Systems (MCS)
Recalling a bit of previous information, when we talk about compressive bandages we are talking about one or more bandages that, applied to the area to be treated, generate compression.
Let us also remember that compression is the sum of other factors:
- The application tension exerted by the professional when making a bandage.
- The overlapping of layers (size of the bandage, application technique, etc…).
- The elasticity of the bandage trying to return to its original elongation.
- The perimeter of the member.
The type of elasticity that the bandage applied in a compression bandage should have is a subject that is still being debated today. That said, some of the greatest exponents in the field of compression, such as Partsch, H or Mosti, G, are clear when it comes to preferably recommending the use of short stretch or short traction bandages.
This thought is reflected in articles such as the one written in 1999 “Inelastic leg compression is more effective to reduce deep venous refluxes than elastic bandages.” Partsch, H (1999), where the need to use short-pull bandages is emphasized due to the greater comfort and better results offered in patients.
Selecting the most appropriate bandage requires the professional to have in-depth knowledge of the materials used to make the bandages, their technical characteristics, and to be trained in the different compression bandage techniques.
When speaking of a compression bandage, the use of several bandages and of different compositions is understood, where the first layer has a protective function, either by means of a padding bandage or a foam bandage; and the second or subsequent layers already have the function of compression itself, mainly by means of elastic compression bandages. Commercially it is possible to purchase these products individually or in compression kits, with all the components that the professional may need and may or may not have visual marks with the compression levels exerted by the bandages, if so, it is very important that the professional follows the application technique recommended by the manufacturer and which is usually in a spiral.
Compression Stockings (Medical grade)
They are marketed with different fabrics of varying elasticity, made in circular knit or flat knit and sizes ranging from short socks to thigh lengths, pantyhose or cycling shorts.
There are four levels of therapeutic compression, although there is no consensus on determining the levels of pressure that are exerted, these compression levels are divided into classes, with level 1 being the lowest and level 4 being the highest. Not having an international consensus generates a bit of confusion in scientific reports.
In order to be considered a medical grade stocking, it must meet a series of requirements where the pressure gradient is considered essential. Therapeutic stockings are those that manage to reduce ambulatory venous hypertension, and are manufactured under strict medical and technical requirements. Specifications include consistency and durability to provide a specific level of pressure on the ankle and decreasing compression graduation.
Unfortunately, many of the compression stockings that are marketed are non-medical support hosiery, which exert non-uniform or graduated pressure, are not certified, do not need to comply with the strict regulations, medical and technical specifications such as the graduation stockings of compression stockings. compression.
Adaptive Compression Systems (ACS) or adjustable Velcro systems
Practically inelastic product that is applied by wrapping the leg and adjusting it with self-adhering velcro, easy for the patient to put on and adjust the pressure to the most comfortable level. Easy to put on by the patient and adjust the pressure to the most comfortable level. It is recommended that the chosen product allows the measurement of pressures within the range stipulated by the prescriber.
Intermittent Compression Systems (ICS)
Designed to apply compression and promote venous return by pumping blood towards the heart. It also prevents the accumulation of blood or lymphatic fluids that cause swelling and pain (post-thrombotic syndrome, PTS). Indicated to support the use of stockings in patients with a high risk of contracting a DVT, due to surgeries, immobility and/or long periods of travel that limit their mobility.
Use when other compression options are not available, cannot be used, or have not helped the venous leg ulcer heal after prolonged compression therapy.
When do we use each of the mentioned systems?
Although it is not clear what is the optimal pressure to achieve ulcer healing, it is still a matter of debate. Yes, some basic criteria can be applied when deciding on which system to use in patients with venous diseases.
On the other hand, it is also known that venous narrowing requires pressures greater than 42 mmHg. That is why low-elastic bandages are the ones that achieve the best healing rates in most cases, as they are more hemodynamically efficient.
In the case of edema treatment, where compression as high as in venous ulcers is not necessary, the use of 20 mmHg compression stockings could be considered convenient. Compression stockings if the ulcers are small and not long lasting may be another option.
In the case of devices with Velcro bands, it can be a good alternative that allows for self-monitoring and does not need to be replaced as often as a compression bandage is replaced. Lastly, and as we have already mentioned, intermittent pneumatic compression is a useful adjunct in patients with restricted mobility.
Below is a table extracted from the article Partsch, H (2013) Advancement in compression treatment for venous leg ulcers, where it mentions these 4 methods and their main applications:
Source: Partsch, H (2013) Advancement in compression treatment for venous leg ulcers
Finally, when applying any of the aforementioned systems, common sense must be used. Each patient in a world and treatments cannot be generalized based on the characteristics of the patient. You always have to think about the comfort of the patient and avoid any system that could cause problems.
- Partsch, H., Menzinger, G. and Mostbeck, A. (1999). Inelastic leg compression is more effective in reducing deep venous reflux than elastic bandages. Dermatologic surgery: official publication of the American Society for Dermatologic Surgery [et al.], 25 9 , 695-700 .
- Partsch, Hugo. (2013). Advancement in compression treatment for venous leg ulcers. J Wound Technol. 19. 20-22.
- Alba Moratilla C. Términos para comprender la compresión terapéutica. Rev. enferm. vasc. [Internet]. 15 de enero de 2022 [citado 17 de julio de 2022];4(Especial):4-32. Disponible en: https://www.revistaevascular.es/index.php/revistaenfermeriavascular/article/view/94
- Partsch H (2003) Understanding the pathophysiological effects of compression. In: EWMA Position Statement; Understanding Compression Therapy 2003. Medical Education Partnership Ltd, London
- Principles of compression in venous disease: a practitioner’s guide to treatment and prevention of venous leg ulcers. Wounds International, 2013. Available from: www.woundsinternational.com