The main characteristic of venous insufficiency is the dilation of veins with faulty valves and is followed by an increase in endovenous pressure.
If external pressure is applied by wearing elastic stockings, veins are emptied of blood and venous hypertension is counterbalanced. Elastic stockings also help a quicker recovery after an invasive treatment because the ecchymotic areas that inevitably appear are significantly less in number and fade in a shorter amount of time.
Graded compression elastic stockings are called this way because they do not apply uniform pressure across the lower limb. The maximum pressure is exerted on the ankle region and decreases on the tibia and even more on the thigh region.
The pressure which the elastic stockings exert on the ankle determines the intended use and is measured in millimeters of mercury (mmHg). Based on this, the stockings are classified into four classes, from class I to class IV. The Class IV stockings exert less pressure, from 14 to 22 mmHg and they are mainly used for the prevention and less for the treatment of venous disorders. The Class II stockings exert pressure from 22 to 30 mmHG and they are the ones more commonly in use, either for the preservative treatment of venous insufficiency or after therapeutic interventions, such as sclerotherapy and endovenous laser treatment of the incompetent greater saphenous vein. The Class III and IV stockings have a more powerful compression and are used for more severe forms of venous insufficiency and chronic venous hypertension, such as lipodermatosclerosis and venous ulcers, as well as for the management of lymphoedema.
Venous insufficiency and lymphoedema are often accompanied by swelling (oedema), especially in the ankle area and at the tibia. The oedema worsens during the course of the day due to gravity and is usually worse in the afternoon hours.
The oedema lessens significantly during sleep, especially if the patient places his legs in an elevated position, and it starts growing again after rising from bed in the morning. The elastic stockings should be worn early in the morning, preferably before the patient gets up, in order to prevent the oedema from increasing during the day.
The stockings should always be removed before going to sleep, except for the first 24 to 48 hours after a surgical treatment and only if the doctor gave such instructions.
Elastic stockings are available in different lengths, such as knee-high, thigh-high, and pantyhose. There are also special compression pregnancy pantyhose and custom elastic stockings for specific applications.
Choosing the right stocking
The selection of the appropriate length of the elastic stocking for each patient depends on the severity of their condition and whether the stockings are prescribed for prevention, for chronic treatment, or after a therapeutic intervention.
The patient's personal preference is important, as his everyday life while wearing the elastic stockings should be as comfortable and pleasant as possible. This helps the patient follow the treatment and also ensures a better quality of life.
The size of the elastic stocking is very important.
The correct size ensures that the pressure, and therefore the treatment, is applied correctly to the limb and that the patient's everyday life while wearing the elastic stockings will be comfortable. If the elastic stocking is larger than it should, the exerted pressure, and therefore its effectiveness, will be less than expected. If, on the other hand, the elastic stocking is smaller than it should, excessive pressure will be exerted and the stocking will not be accepted by the patient. Patients who had previous bad experience with stockings and are upset when the doctor explains that their use is essential for the proper treatment of their disease, usually fall into this category.
The selection of the right size is successful by getting specific leg measurements. As it was previously mentioned, gravity causes the oedema to increase during the course of the day. Therefore, the leg measurements should be taken during the morning hours, even before the patient gets up. Ideally, they should be taken by the patient or someone close to them, at home, right after the morning awakening. In case this is not possible, the patient should lie down and place his legs in an elevated position for at least 30 minutes prior to taking the measurements. The measurements taken by pharmacy personnel in the afternoon and over the clothes are usually incorrect and might lead to all the consequences previously mentioned.
The sites where we must take the measurements of the limb are:
- Position B - the area just above the ankle
- Position C - the circumference of the widest part of the tibia
- Position D - just below the knee
- Position F - at the thigh and 14 cm from the knee
- Position G - 5 cm below the inguino-crural fold (crotch)
Proper use of elastic stockings
Elastic stockings should be worn first thing in the morning, even when the oedema is minimal, and removed in the evening before bedtime. During the midday rest there is no need to remove them, but in case they are removed, they should be put back on before getting out of bed.
If elastic stockings have been prescribed for prevention rather than treatment, it may not be necessary to wear them throughout the day, but only, for example, when the patient is at work.
There are cases where the elastic stockings should also be worn at night during sleep. These cases usually, but not strictly, involve the first days after invasive treatment, sclerotherapy, or endovenous laser therapy and are always accompanied by the attending physician's appropriate instructions.
The shelf life of the elastic stocking is determined by the manufacturer and they can usually be worn for up to 6 months. After this period of time the weave of the stockings lose their elasticity and they should be replaced.
Patients who must wear graded compression elastic stockings have to know that they provide very important assistance to venous insufficiency, but they are effective only as long as they wear them.
In other words, when they stop using the stockings there will be a recurrence of their problems in a short amount of time.
Additionally, it is logical that it becomes extremely difficult for the patient to wear the elastic stockings on a permanent basis and that it often leads to problems of compliance with all the previously mentioned consequences for venous insufficiency.
Currently there are many painless treatment methods which are followed by very good long-lasting results, both functionally and cosmetically. Therefore, they are highly recommended for the permanent treatment of varicose veins and spider veins.