Knee versus thigh length graduated compression stockings for prevention of deep venous thrombosis: a systematic review.
ABSTRACT Graduated compression stockings are a valuable means of thrombo-prophylaxis but it is unclear whether knee-length (KL) or thigh length (TL) stockings are more effective. The aim of this review was to systematically analyse randomised controlled trials that have evaluated stocking length and efficacy of thromboprophylaxis.
A systematic review of the literature was undertaken. Clinical trials on hospitalised populations and passengers on long haul flights were selected according to specific criteria and analysed to generate summated data.
14 randomized control trials were analysed. Thirty six of 1568 (2.3%) participants randomised to KL stockings developed a deep venous thrombosis, compared with 79 of 1696 (5%) in the TL control/thigh length group. Substantial heterogeneity was observed amongst trials. KL stockings had a significant effect to reduce the incidence of DVT in long haul flight passengers, odds ration 0.08 (95%CI 0.03-0.22). In hospitalised patients KL stockings did not appear to be far worse than TL stockings, odds ratio 1.01 (95%CI 0.35-2.90). For combined passengers and patients, there was a benefit in favour of KL stockings, weighted odds ratio 0.45 (95% CI 0.30-0.68).
KL graduated stockings can be as effective as TL stockings for the prevention of DVT, whilst offering advantages in terms of patient compliance and cost.
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ABSTRACT: BACKGROUND: Up to half of patients with proximal deep venous thrombosis (DVT) will develop Post-thrombotic syndrome (PTS) despite optimal anticoagulant therapy. PTS significantly impacts upon quality of life and has major health-economic implications. OBJECTIVE: This narrative review describes the pathophysiology, risk factors as well as diagnosis, prevention and treatment of PTS to improve understanding of the disease and guide treatment. METHODS: Relevant papers were identified through systematic searches of Pubmed, EMBASE and Cochrane databases between 1966 to November 2011. Studies were included for detailed assessment if they met the following criteria: published in English, human study participants, study population >18 yrs, lower limb post-thrombotic syndrome. All non-systematic reviews and single patient case reports were excluded. CONCLUSIONS: Recurrent thrombosis, thrombus location and obesity are major risk factors while the importance of, gender and age remain uncertain. Diagnosis of PTS is based on clinical findings in patients with known history of DVT. Several clinical scales have been described with the Villalta Score gaining increasing popularity. Adequate anticoagulation and use of elastic compression stockings (ECS) following DVT can reduce the incidence of PTS. Catheter directed thrombolysis and mechanical thrombectomy of acute DVT may preserve valvular function. Studies to date of these techniques are encouraging and have reported improved haemodynamics and a reduced incidence of PTS. The management of established PTS is challenging. Compression therapy, aimed at reducing the underling venous hypertension, remains the mainstay of treatment. This is despite a paucity of high quality evidence to support their use. Pharmacological and surgical treatments have also been described with a number of studies citing symptomatic improvement. © 2013 International Society on Thrombosis and Haemostasis.Journal of Thrombosis and Haemostasis 02/2013; 11(5). · 6.08 Impact Factor
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ABSTRACT: Background Compression therapy constitutes the cornerstone of prevention of post-thrombotic syndrome in patients with deep-vein thrombosis (DVT). However, no consensus has been reached regarding the optimal timing for initiation, duration, and strength of compression therapy. Objective To document prescribing practices of compression therapy in case of DVT by French Vascular Medicine physicians. Methods E-mail survey sent in 2009 to all physicians members of the French Society of Vascular Medicine. Results Seven hundred and sixty-one vascular medicine physicians (56.6% private practice, 19.8% hospital-based and 23.6% both private practice and hospital-based physicians) responded. At diagnosis, 94.3% (n = 707) systematically prescribed compression therapy. The initial compression consisted in elastic compression stockings (ECS) for 57.3% of patients (n = 426) and in bandages for 42.7% (n = 317). When physicians initially prescribed bandages, in 92.3% of cases they later switched to elastic compression stockings (ECS). Finally, 95.8% (n = 712) of vascular medicine physicians reported prescribing ECS during DVT follow-up. The ECS ankle pressure gradient was 15–20 mmHg in 64.3% of cases and 20–36 mmHg in 35.5%. Most physicians (85.9%, n = 631) modulated the duration of compression therapy according to the results of follow-up compression ultrasonographic explorations. Only a limited proportion of physicians took into account thrombus localization or its initial extention. Conclusion In case of DVT, French vascular medicine physicians systematically prescribed compression therapy. However, the strength of compression was lower than recommended by international guidelines. Efficacy and benefits (potential better compliance) of this common practice should be assessed with a randomized controlled trial.Journal des Maladies Vasculaires 06/2012; 37(3):140–145. · 0.24 Impact Factor
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ABSTRACT: BACKGROUND: Graduated elastic compression (GEC) stockings have been demonstrated to reduce the morbidity associated with post-thrombotic syndrome. The ideal length or compression strength required to achieve this is speculative and related to physician preference and patient compliance. The aim of this study was to evaluate the hemodynamic performance of four different stockings and determine the patient's preference. METHODS: Thirty-four consecutive patients (40 legs, 34 male) with post-thrombotic syndrome were tested with four different stockings (Mediven plus open toe, Bayreuth, Germany) of their size in random order: class 1 (18-21 mm Hg) and class II (23-32 mm Hg), below-knee (BK) and above-knee thigh-length (AK). The median age, Venous Clinical Severity Score, Venous Segmental Disease Score, and Villalta scale were 62 years (range, 31-81 years), 8 (range, 1-21), 5 (range, 2-10), and 10 (range, 2-22), respectively. The C of C(0-6)E(s)A(s,d,p)P(r,o) was C(0) = 2, C(2) = 1, C(3) = 3, C(4a) = 12, C(4b) = 7, C(5) = 12, C(6) = 3. Obstruction and reflux was observed on duplex in 47.5% legs, with deep venous reflux alone in 45%. Air plethysmography was used to measure the venous filling index (VFI), venous volume, and time to fill 90% of the venous volume. Direct pressure measurements were obtained while lying and standing using the PicoPress device (Microlab Elettronica, Nicolò, Italy). The pressure sensor was placed underneath the test stocking 5 cm above and 2 cm posterior to the medial malleolus. At the end of the study session, patients stated their preferred stocking based on comfort. RESULTS: The VFI, venous volume, and time to fill 90% of the venous volume improved significantly with all types of stocking versus no compression. In class I, the VFI (mL/s) improved from a median of 4.9 (range, 1.7-16.3) without compression to 3.7 (range, 0-14) BK (24.5%) and 3.6 (range, 0.6-14.5) AK (26.5%). With class II, the corresponding improvement was to 4.0 (range, 0.3-16.2) BK (18.8%) and 3.7 (range, 0.5-14.2) AK (24.5%). Median stocking pressure (mm Hg) as measured with the PicoPress in class I was 23 (range, 12-33) lying and 27 (range, 19-39) standing (P < .0005) and in class II was 28 (range, 21-40) lying and 32 (range, 23-46) standing (P < .0005). There was a significant but weak correlation (Spearman) between stocking interface pressure measured directly with the PicoPress and the VFI improvement (baseline VFI-compression VFI) at r = .237; P = .005. Twenty-one patients (legs) changed their preference of compression and 38% of these (8/21 patients, 9/21 legs) preferred an AK-GEC stocking. CONCLUSIONS: Compression significantly improved all hemodynamic parameters on air plethysmography. However, the hemodynamic benefit did not significantly change with the class or length of stocking. These results support the liberal selection of a GEC stocking based on patient preference.Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 02/2013; · 2.98 Impact Factor
Follow up consisted of clinical evaluation, ankle-brachial index measure-
ments and duplex scanning.
Results The mean follow-up time was 30.1 months. The mean length
of the endarterectomised SFAs was 29 cm (range, 15–43 cm). The five year
cumulative primary patency rate by means of life table analysis was
45.8?4.4% (SE). Percutaneous transluminal balloon angioplasty and surgi-
cal re-interventions were performed in thirty three and five patients respec-
tively resulting in a primary assisted patency rate of 57.5?4.1%. The five year
secondary patency rate was 65.6?3.8%. Limb salvage was achieved in 35 of
the 41 patients with gangrene.
Conclusions The long term results of ultrasonic SFA endarterectomy
suggest this is an effective technique.
An “All-Comers” Venous Duplex Scan Policy for Patients with Lower
Limb Varicose Veins Attending a One-stop Vascular Clinic: Is It
Makris S.A., Karkos C.D., Awad S., London N.J.M.. Eur J Vasc Endovasc
Objective To determine whether clinical assessment could predict the
correct management of patients with varicose veins (VVs), select those who
would need duplex scanning, and identify deep venous reflux (DVR).
Methods Prospective study of 342 consecutive limbs with VVs. These
were divided into 3 groups: 170 (50%) limbs with primary VVs without skin
changes (group I), 37 (11%) with recurrent VVs without skin changes
(group II), and 135 (39%) with primary or recurrent VVs with skin changes
(group III). Clinicians were asked to document whether they would nor-
mally request a duplex scan because of clinical uncertainty. Agreement
between decision-making based on clinical and on duplex findings was
Results Agreement between clinical and duplex findings for groups I,
II, and III was 82%, 59%, and 67%, respectively. In 112 cases (66%) in group
I, clinicians felt certain about the diagnosis and yet duplex scanning revealed
they were wrong in 12% of cases. In group II, clinicians would request a
duplex scan because of clinical uncertainty in 30 (81%) cases. In group III,
the sensitivity, specificity, positive and negative predictive value of clinical
assessment in detecting DVR was 32%, 77%, 24%, and 83%, respectively.
Conclusions Clinical evaluation of patients with VVs is unreliable in
planning their management. Clinicians can neither predict those who will
require duplex scanning nor correctly identify DVR. Even experienced
surgeons often “get it wrong” when assessing primary uncomplicated veins
imaging policy should be implemented if optimal management is to be
Knee versus Thigh Length Graduated Compression Stockings for
Prevention of Deep Venous Thrombosis: A Systematic Review
Sajid M.S., Tai N.R.M., Goli G., Morris R.W., Baker D.M., Hamilton G..
Eur J Vasc Endovasc Surg 2006;32:730-36.
Objective Graduated compression stockings are a valuable means of
thrombo-prophylaxis but it is unclear whether knee-length (KL) or thigh
length (TL) stockings are more effective. The aim of this review was to
ing length and efficacy of thromboprophylaxis.
Method A systematic review of the literature was undertaken. Clinical
trials on hospitalised populations and passengers on long haul flights were
selected according to specific criteria and analysed to generate summated
Results 14 randomized control trials were analysed. Thirty six of 1568
(2.3%) participants randomised to KL stockings developed a deep venous
thrombosis, compared with 79 of 1696 (5%) in the TL control/thigh length
group. Substantial heterogeneity was observed amongst trials. KL stockings
had a significant effect to reduce the incidence of DVT in long haul flight
passengers, odds ration 0.08 (95%CI 0.03–0.22). In hospitalised patients
KL stockings did not appear to be far worse than TL stockings, odds ratio
1.01 (95%CI 0.35–2.90). For combined passengers and patients, there was
a benefit in favour of KL stockings, weighted odds ratio 0.45 (95% CI
Conclusion KL graduated stockings can be as effective as TL stockings
for the prevention of DVT, whilst offering advantages in terms of patient
compliance and cost.
JOURNAL OF VASCULAR SURGERY
Volume 44, Number 6