Clinical Effects Of Compression Therapy

The use of compression therapy in various clinical indications is based mainly on experience.

Only a few randomized controlled trials (RCTs) are available that prove the efficacy of compression treatment on the level of evidence-based medicine.25

Table 10.4 summarizes the outcome of an international consensus meeting in which all RCTs and systematic reviews have been scored.

Up to now there are only three areas for which evidence-based medicine data show clear clinical benefits of compression therapy: active venous ulceration, prevention of postthrombotic syndrome after deep vein thrombosis, and prevention of thromboembolic events after surgery when combined with anticoagulatory prophylaxis.

In venous ulcers several RCTs have shown that compression is better than no compression and that high pressure is more effective than low pressure. Conflicting results are coming from studies comparing different compression materials, mainly due to the fact that frequently, good bandages have been compared with poor bandages applied by inadequately trained staff. This underlines the need to measure pressure and stiffness of the compression products in future trials.

Compression stockings after proximal deep vein thrombosis (DVT) are able to reduce the incidence of a postthrom-botic syndrome some years after the acute event to one half. Immediate mobilization of mobile patients with DVT using compression has been shown not only to reduce pain and swelling in the acute stage but also to achieve less post-thrombotic changes after some years.

The overview given in Table 10.4 does not mean that compression is less or not effective in areas with recommendation levels B and C, but that we need more trials in order to improve the scientific evidence for compression devices in the future.

References

1. CEN European Prestandard. Medical compression hosiery, European Committee for Standardization. Brussels. 2001. 1-40.

2. Partsch H, Rabe E, Stemmer R. Compression therapy of the extremities. Paris: Editions Phlebologiques Francaises. 1999.

3. Partsch H, Clark M, Bassez S, Becker F, Benigni JP, Blazek V et al. Measurement of lower leg compression in vivo: Recomendations for the performance of measurements of interface pressure and stiffness: A consensus statement, Dermatol Surg. 2006. 32: 229-238.

4. Partsch H, Menzinger G, Mostbeck A. Inelastic leg compression is more effective to reduce deep venous refluxes than elastic bandages, Dermatol Surg. 1999. 25: 695-700.

5. Stolk R, Wegen van der-Franken CPM, Neumann, HAM. A method for measuring the dynamic behavior of medical compression hosiery during walking, Derm Surg. 2004. 30: 729-736.

6. Partsch H. The static stiffness index. A simple method to assess the elastic property of compression material in vivo, Dermatol Surg. 2005. 31: 625-630.

7. Partsch H. Improvement of venous pumping function in chronic venous insufficiency by compression depending on pressure and material, VASA. 1984. 13: 58-64.

8. Dai G, Tsukurov O, Orkin RW, Abbott WM, Kamm RD, Gertler JP. An in vitro cell culture system to study the influence of external pneumatic compression on endothelial function, J Vasc Surg. 2000. 32: 977-987.

9. Cullum N, Nelson EA, Fletcher AW, Sheldon TA. Compression for venous leg ulcers (Cochrane review). In: The Cochrane Library, Issue 2, 2002. Oxford: Update software.

10. Kessler CM, Hirsch DR, Jacobs H et al. Intermittent pneumatic compression in chronic venous insufficiency favorably affects fibrinolytic potential and platlet activation, Blood Coagul Fibrinolysis. 1996. 7: 437-446.

11. Blättler W, Partsch H. Leg compression and ambulation is better than bed rest for the treatment of acute deep vein thrombosis, Int Angiol.

12. Vin F, Benigni JP. Compression therapy. International Consensus Document Guidelines according to scientific evidence, Int Angiol.

13. Partsch H, Winiger J, Lun B. Compression stockings reduce occupational swelling, J Derm Surg. 2004. 30: 737-743.

14. Partsch B, Partsch H. What is the optimum pressure dose for leg vein compression therapy? J Vasc Surg. 2005. 42: 734-738.

15. Partsch H, Kahn P. Venöse Strömungsbeschleunigung in Bein und Becken durch "Anti-Thrombosestrümpfe." Klinikarzt. 1982. 11: 609615.

16. Lord RS, Hamilton D. Graduated compression stockings (20-30 mm Hg) do not compress leg veins in the standing position, ANZ J Surg. 2004. 74: 581-583.

17. Mostbeck A, Partsch H, Peschl L. Änderungen der Blutvolumenverteilung im Ganzkörper unter physikalischen und pharmakologischen Maßnahmen, VASA. 1977. 6: 137-141.

18. Partsch H, Menzinger G, Borst-Krafek B, Groiss E. Does thigh compression improve venous hemodynamics in chronic venous insufficiency? J Vasc Surg. 2002. 36: 948-952.

19. Partsch B, Mayer W, Partsch H. Improvement of ambulatory venous hypertension by narrowing of the femoral vein in congenital absence of venous valves, Phlebology. 1992. 7: 101-104.

20. Stöberl C, Gabler S, Partsch H. Indikationsgerechte Bestrumpfung— Messung der venösen Pumpfunktion, VASA. 1989. 18: 35-39.

21. Mayrovitz HN. Compression-induced pulsatile blood flow changes in human legs, Clin Physiol. 1998. 18: 117-124.

22. Delis KT, Nicolaides AN. Effect of intermittent pneumatic compression of foot and calf on walking distance, hemodynamics, and quality of life in patients with arterial claudication: A prospective randomized controlled study with 1-year follow-up. Ann Surg. 2005. 241(3): 431441.

23. Abu-Own A, Shami SK, Chittenden SJ, Farrah J, Scurr JH, Smith PD. Microangiopathy of the skin and the effect of leg compression in patients with chronic venous insufficiency, J Vasc Surg. 1994. 19: 1074-1083.

24. Földi E, Jünger M, Partsch H. The science of lymphoedema bandaging, EWMA Focus Document. Lymphoedema bandaging in practice. London:MEP Ltd. 2005. pp. 2-4.

25. Partsch H, ed. Evidence based compression therapy, VASA. 2003. Suppl. 63.

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