Lim, Chung Sim; Davies, Alun H, et al.
Canadian Medical Association Journal. Date of publication 2014 Jul 8;volume 186(10):E391-8.
Compression therapy is a frequently used physical therapy in conditions involving venous and lymphatic insufficiency in the lower limbs, including varicosities, lymphedema, venous eczema and ulceration, deep vein thrombosis and postthrombotic syndrome. The many forms of compression therapy include elastic and non-elastic bandages, boots, hosiery or stockings (Box 1), and pneumatic devices.1 Graduated compression stockings (Figure 1) are often prescribed and have the advantage of being more acceptable, relatively easier to put on and less cumbersome than bandaging and pneumatic devices. However, not all patients tolerate graduated compression stockings, and problems with compliance are not uncommon. Box 1: Types of compression stockings Graduated or medical compression stockings Graduated compression stockings exert the greatest degree of compression at the ankle, and the level of compression gradually decreases up the garment They are often used to treat chronic venous disease and edema They are designed for ambulatory patients and are manufactured under strict medical and technical specifications, including consistency and durability, to provide a specific level of ankle pressure and graduation of compression Antiembolism stockings Antiembolism stockings are used to reduce the risk of deep vein thrombosis Like graduation compression stockings, they provide gradient compression They are designed for bedridden patients and do not meet the technical specifications for use by ambulatory patients Although the terms “antiembolism stockings” and “graduated compression hosiery” are often used interchangeably and both types of stockings offer graduated compression, they have different levels of compression and indications Nonmedical support hosiery Nonmedical support hosiery, including flight socks and elastic support stockings, are often used to provide relief for tired, heavy and aching legs They usually exert considerably less compression than graduated compression stockings The compression is uniform and not graduated They do not need to meet the strict medical and technical specifications as those of graduated compression stockings They can often be bought over the counter without a prescription Figure 1: Below-knee and thigh-length compression stockings. We review the current evidence of the therapeutic roles of graduated compression stockings and the problems associated with their use. The evidence used in this review is described in Box 2. Box 2: Summary of the literature review We searched PubMed to identify peer-reviewed original research articles, meta-analyses and reviews (the last search was on July 31, 2013, with no restriction to publication dates). Search terms were “compression stockings,” “compression hosiery” and “elastic stockings.” We included articles if the studies involved humans, the article was published in English and the topic related to venous thromboembolism, venous disease, venous insufficiency or ulcer, superficial thrombophlebitis, varicose veins, leg lymphedema, pregnancy, postthrombotic syndrome or chronic edema. We manually searched bibliographies of reviewed articles to expand the literature search. In addition, we consulted clinical practice guidelines.
