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Compression therapy is the first line of conservative treatment for individuals with venous disease in the legs. Patients wear specialized elastic fabric stockings or bandages that maintain a constant pressure around the leg: below the knee, above the knee, or around the entire leg. Regular wearing of the stockings is the standard method used to improve venous function, relieve pain and swelling, and improve quality of life.1 Compression stockings are thought by many physicians to prevent the development of Post-Thrombotic Syndrome (PTS) —a more serious and debilitating venous disorder that usually reflects a worsening of Deep Vein Thrombosis (DVT) symptoms.1
Use of Compression Therapy for DVT Patients
Between 20% and 50% of patients with DVT develop PTS within two years depending on whether preventative measures are taken.2 For some patients, putting on the stockings is difficult and for others, the stockings are uncomfortable and a burden to wear.3 Two trials compared the development of PTS in DVT patients who either wore compression stockings or wore no stockings.4,5 The results of these trials showed significant benefits for those wearing compression stockings for 6 to 76 months. However, more recent comparative studies showed no statistical difference in the development of PTS in patients who wore compression stockings compared to those who wore placebo stockings or no stockings at all.6-8 Last, a group of researchers analyzed available studies comparing compression stockings to placebo stockings or no stockings for prevention of PTS in patients with DVT.9 They concluded that elastic compression stockings are unlikely to prevent death or recurring venous thromboembolism.
Differences in the outcomes of the various studies may result from different levels of patient health, different degrees of patient willingness to wear the stockings as prescribed, and different periods between the diagnosis of their DVT and when the patients began wearing the stockings. Further research is needed, since not every patient with DVT will develop post-thrombotic syndrome—even without compression—and PTS cannot be prevented by compression therapy alone in every patient.3
It is reasonable for patients with symptomatic PTS to undergo a therapeutic trial of compression stockings and to continue with them for as long as they experience relief.10 Those patients who do not experience relief of their symptoms may want to consider venous stenting to expand the narrowed vein as an alternative therapy to relieve pain, swelling, and ulcer symptoms, and to improve quality of life.
Venous stenting is when a metal mesh tube is placed in the narrowed region of the vein. The procedure can be performed with low risk to the patient, long-term high patency (open) rate, and low rate of re-occlusion (blockage) of the stent. It is usually a same-day, minimally invasive procedure. The procedure involves a small incision in the leg, ultrasound and venography to guide the procedure, and is performed under general or local anesthesia. Long term (5 year) studies have shown that venous stenting alone is successful in alleviating symptoms, reducing pain and swelling, healing of ulcers and reduction of reoccurrence, and improvement in quality of life.11
- Jeanneret C, Karatolios K, von Planta I. Impact of compression stockings on calf-vein diameters and on quality of life parameters in subjects with painful legs. Vasa. 2014;43(4):268–77.
- Baldwin MJ, Moore HM, Rudarakanchana N, et al. Post-thrombotic syndrome: a clinical review. J Thromb Haemost. 2013;11(5):795–805.
- Burgstaller JM, Steurer J, Held U, Amann-Vesti B. Efficacy of compression stockings in preventing post-thrombotic syndrome in patients with deep venous thrombosis: a systematic review and metaanalysis. Vasa. 2016;45(2):141–7.
- Brandjes DPM, Buller HR, Heijboer H, et al. Randomized trial of effect of compression stockings in patients with symptomatic proximal-vein thrombosis. Lancet 1997;349(9054):759–62.
- Prandoni P, Lensing AWA, Prins MH, et al. Below-knee elastic compression stockings to prevent the post-thrombotic syndrome—a randomized controlled trial. Ann Intern Med. 2004;141(4):249–56.
- Kahn SR, Shapiro S, Well PS, et al. Compression stockings to prevent post-thrombotic syndrome: a randomized controlled trial. Lancet. 2014;383(9920):880–8.
- Ginsberg JS, Hirsh J, Julian J, et al. Prevention and treatment of postphlebitic syndrome—results of a 3-part study. Arch Intern Med. 2001;161(17):2105–9.
- Ashwanden M, Jeanneret C, Koller MT, et al. Effect of prolonged treatment with compression stockings to prevent post-thrombotic sequelae: a randomized controlled trial. J Vasc Surg. 2008;47(5):1015–21.
- Berntsen CF, Kristiansen A, Akl EA, et al. Compression stockings for preventing the postthrombotic syndrome in patients with deep vein thrombosis. Am J Med. 2016;129(4):447.e1–447.e20.
- Liu D, Peterson E, Dooner J, et al for the Interdisciplinary Expert Panel on Iliofemoral Deep Vein Thrombosis (InterEPID). Diagnosis and management of iliofemoral deep vein thrombosis: clinical practice guideline. CMAJ. 2015;187(17):1288–96.
- Neglén P, Hollis KC, Olivier J, Raju S. Stenting of the venous outflow in chronic venous disease: long-term stent-related outcome, clinical, and hemodynamic result. J Vasc Surg. 2007;46(5):979-990