Compression: The Not-So-Secret Weapon of Vein Specialists
The best board-certified vein specialists are always looking for innovative ways to treat patients’ vein disease at the source of the problem. Minimally invasive treatments such as endovenous laser ablation (EVLA) and sclerotherapy have been joined by newer procedures, including mechanico-chemical ablation, and cyanocryalate adhesives. We often turn to a tried and true technology to help patients manage their vein symptoms: compression.
The Basics
Graduated compression stockings can prevent vein problems from occurring, relieve symptoms, and decrease the likelihood of a blood clot. Patients frequently report that their symptoms are significantly improved, if not completely alleviated, while wearing compression.
Compression therapy provides an alternative for patients who opt for a more conservative treatment. Stockings can be worn for years as a long-term option for managing symptoms of venous disease.
Venous disease is defined as the impairment of blood flow towards the heart. Healthy veins have valves that open and close to assist the return of blood to the heart. Venous disease occurs if these valves become damaged, allowing the backward flow of blood in the legs. When blood cannot be properly returned through the vein, it can pool, leading to a feeling of heaviness and fatigue and cause varicose veins, among other problems.
Medical compression provides a gradient of pressure against the leg; the pressure is highest at the foot and ankle and gradually decreases as the garment rises up the leg. This pressure gradient makes it easier for the body to pump blood up towards the heart (the normal direction) and more difficult for gravity to pull blood downward. Compression increases the pressure in the subcutaneous tissue, thereby helping to reduce and prevent swelling by moving excess fluid back into the capillaries.
Gradient compression is expressed in millimeters of mercury, or mmHg. It is the measurement of how much compression or squeeze that is placed on the leg; the higher the number, the greater the compression. Stockings are graded on the basis of the strength of the compression at the ankle. Commonly prescribed strengths include 15-20 mmHg for spider veins or patients with varicose veins but only mild symptoms or swelling; 20-30 mmHg for mild to moderate varicose veins; and 30-40 mmHg for patients with varicose veins associated with symptoms such as pain and swelling. For conditions such as lymphedema, 50-60 mmHg stockings or inelastic bandages are most effective.
Compression Gains Traction
Athletic compression and post-thrombotic (clot) compression garments, such as those worn by tennis star Venus Williams, have raised consumers’ awareness of compression. Add to that frequent travel stories about so-called “economy-class syndrome,” and public awareness of compression appears to be growing. In recent years, there has been increased consumer interest in compression for occupational use as more teachers, hair stylists, and other professionals who are on their feet all day look for relief for their tired, achy legs.
Now that there is a multitude of products to choose from, however, consumers should be judicious about what they are purchasing and why. Non-medical compression may help your legs feel better, but if you have varicosities, venous reflux, edema, or lymphatic issues, then it could actually be dangerous to wear consumer compression products if they’re not the appropriate size or don’t have the structure of a medical-grade compression garment.
Someone who scores poorly on the Ankle-Brachial Index (ABI) test, for example, should not be using compression because the test may indicate peripheral artery disease (PAD). This condition of blockages in the arteries of the arms or legs would mean greater risk for a stroke or heart attack, a condition that could be exacerbated by the use of compression. Likewise, those with sensory impairments due to diabetes and neuropathy (nerve damage) should also be cautious with regard to compression.
The best practice is to consult with a medical professional to get the proper diagnosis for your specific condition in order to find the most beneficial compression. They will prescribe different types of garments depending on the type of disease, the location of the damage to the veins, and how far it has progressed. Different lengths of compression garments may be recommended, including knee-length, thigh-length and full pantyhose-style garments. There are special designs for men and pregnant women.
Like any product, the quality of compression products varies. Inexpensive compression socks might not have any therapeutic benefits or worse, the product is ill-fitting or the incorrect dosage. Some lower quality garments may be harder to get on and off, and they’re often not as durable.
The bottom line is that compression makes legs feel better. As a doctor I’m always on my feet, so I wear 20-30mmHg socks or stockings almost every day. Graduated compression fights and beats gravity, keeping the blood efficiently circulating back up to my heart. Even if I weren’t a vein specialist prescribing it to my patients, I would still tout the benefits of compression because my legs feel so good at the end of the day.
Dr. Cindy Asbjornsen is the founder of the Vein Healthcare Center in South Portland, Maine. Certified by the American Board of Venous and Lymphatic Medicine, she cares for all levels of venous disease, including spider veins, varicose veins, and venous ulcers. You can contact Dr. Asbjornsen at 207-221-7799 or [email protected].
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