Better wearing comfort of knee-length elastic compression stockings with an interface pressure of 18-21 mmHg compared to 23-32 mmHg in elderly people after a one day trial - Influence on foot deformities, rheumatism and arthritis.

BACKGROUND: Although the efficacy of compression therapy through knee-length compression stockings with an interface pressure of 18-21 mmHg for leg oedemas has been confirmed by many studies, 91% of patients are still treated with a higher interface pressure. METHOD: In this prospective open randomised monocentric study 19 patients (age ≥65, movement restrictions and symptomatic leg oedema) received knee-length compression stockings with an interface pressure of 18-21 mmHg (stocking type 1) and 23-32 mmHg (stocking type 2). On two consecutive days each of the two compression stocking types were worn for at least 8 hours. After this test period, both stocking types were assessed subjectively and skin changes were recorded. RESULT: A significantly (p-value <0.001) subjective improvement of the symptoms and complaints based on leg oedema was reported with the knee-length compression stockings. The Stocking type 1 recorded a significantly (p = 0,045) better wearing comfort. In addition, the Stocking type 2 was significantly too large amongst women in the front foot area (p = 0.044). The most common side effects were constrictions on the proximal lower leg (stocking type 1 = 73,7% (14/19); stocking type 2 = 78,9% (15/19)). Subjects with arthritis (p = 0.006), hallux valgus (p = 0.034) and/or digitus flexus (p = 0.021) found the socking type 1 significantly more comfortable. CONCLUSION: In order to achieve optimal patient compliance it is recommended to prescribe knee-length compression stockings with an interface pressure of 18-21 mmHg if the following criteria are met: age ≥65 years, female sex, arthritis, digitus flexus (claw toe) or hallux valgus.

Impact of compression stockings on leg swelling after arthroscopy - a prospective randomised pilot study.

BACKGROUND: Post-operative limb swelling may negatively affect the outcome of arthroscopic surgery and prolong rehabilitation. The aim of this pilot study was to evaluate the effect of compression stockings versus no compression on post-operative swelling and pain in the early post-operative phase. METHODS: A single-centre, randomised controlled trial was performed. Patients who underwent minor knee arthroscopy were randomised to wear class II compression stockings (23-32 mmHg) (CS) or no compression stockings (NCS) immediately post-operatively for ten days. All patients received low molecular weight heparin (LMWH) at prophylactic dosage. The primary outcome variable was post-operative swelling of the limb, quantified by using an optical 3D measurement system (Bodytronic© 600). Pain was rated on a visual analogue scale (VAS). From a total of 76 patients assessed, 19 patients were eligible for final analysis. The trial followed the CONSORT criteria, was registered at clinicaltrial.gov and approved by the local ethics committee. RESULTS: The circumference at the middle thigh (cF) was significantly different between groups at day 10 (p = 0.032; circumference - 1.35 ± 2.15% (CS) and + 0.79 ± 3.71% (NCS)). Significant differences were also noted around the knee (cD) at day 10 (p = 0.026) and a significant trend at cD and at the mid lower leg (cB1) at day 4. The volume of the thigh was also different with marked difference between days 1 and 4 between the two groups (p = 0.021; volume + 0.54 ± 2.03% (CS) and + 4.17 ± 4.67 (NCS)). Pain was lower in compression group (not statistically significant). CONCLUSIONS: Post-operative limb swelling can be reduced significantly by wearing compression stockings in the early post-operative phase when compared to not wearing stockings. This may improve the rehabilitation process after arthroscopic surgery. The optimal duration of compression therapy seems to be between three and ten days. TRIAL REGISTRATION: clinicaltrials.gov ( NCT02096562 , date of registration 11.11.2013).

Heterogeneity in venous disease practice patterns amongst primary healthcare practitioners.

INTRODUCTION: This study aimed to describe the practice patterns of primary healthcare practitioners who diagnose and manage venous disease to determine differences in clinical evaluation of disease, recognition of venous ulcers, and referral patterns. METHODS: A survey was distributed at the August 2011 Primary Care Medical Conference (Pri-Med) in Baltimore, Maryland. Pri-med is a medical education company that caters to the continued professional development needs of a variety of physicians. RESULTS: A total of 305 surveys were completed. Of the respondents, 91% were physicians and 9% were advanced level practitioners. In all, 93% prescribed compression stockings as first-line treatment. Heterogeneous referral patterns were reported with 81% referring to vascular surgery, 25% to a vein clinic, 10% to interventional radiology, and 3% to interventional cardiology. Up to 35% responded that they met resistance (did not have their referral accepted) when attempting referral to a vascular surgery colleague. There was substantial variation when asked about the treatment of deep vein thrombosis with 88% starting anticoagulation therapy, 54% prescribing compression stockings, 40% doing a thrombophilia workup, and 25% referring for lytic therapy. CONCLUSION: Diagnosis and management aptitude of venous disease is highly variable. Further grassroots education is required to improve diagnosis and treatment in patients with chronic venous disease.

New advances in compression therapy for venous leg ulcers.

Leg ulceration, often caused by venous stasis, arterial insufficiency, or both, is a common chronic health condition often associated with a prolonged healing trajectory and frequent recurrence. It is estimated that approximately 1.5 to 3.0 per 1,000 adults have active leg ulcers, and the prevalence continues to increase due to an aging population. Management of chronic edema using compression is crucial to promote healing of venous leg ulcers. The principle of compression therapy is simple, involving the use of external pressure in the forms of bandages or wraps to move the fluid from the interstitial space back into the intravascular compartment and prevent reflux. This article synthesizes and appraises the evidence for various types of compression therapies. It also addresses best practice recommendations for the management of leg ulcers when arterial circulation is considered suboptimal.

Effect of the neutral CLOTS 1 trial on the use of graduated compression stockings in the Efficacy of Nitric Oxide Stroke (ENOS) trial.

BACKGROUND AND PURPOSE: Current evidence suggests that the time lag from the publication of randomised clinical trial results to changes in prescribing behaviour for drugs is gradually reducing. However, the effect of results of clinical trials of devices and non-pharmacological interventions on clinical practice is less clear. METHODS: Prospective data from the ongoing international 'Efficacy of Nitric Oxide Stroke' (ENOS) trial were analysed to assess the use of graduated compression stockings (GCS) for deep vein thrombus (DVT) prophylaxis in acute stroke patients before and after publication of the large 'Clots in Legs Or sTockings after Stroke' (CLOTS-1) trial. RESULTS: Data on GCS use were available for 1971 patients with acute stroke enrolled into ENOS from February 2003 to April 2011; of these, 498 (25.3%) wore GCS. Prior to publication of CLOTS-1, GCS use was common (>50%) in the UK, Australasia and Canada but infrequent in Asia and the rest of Europe. After publication of CLOTS-1, use of GCS in the UK declined from 398/656 (61%) to 20/567 (4%) (p<0.001) but not elsewhere (eg, in Australasia (57% before publication vs 70% after publication, p=0.24, but based on small numbers). Practice change was apparent within 3 months of the study publication and was sustained thereafter. There was no change in DVT rates before and after CLOTS-1 (0.8% vs 1.0%). CONCLUSIONS: GCS use declined dramatically following the reporting of the CLOTS-1 trial. The results support the notion that a neutral trial of a device can influence clinical practice rapidly, which is important with a widely used and moderately expensive (time and finance) intervention.

Prevención de la Enfermedad Tromboembólica Venosa (ETEV) en el Paciente Crítico. Evaluación del riesgo y protocolo de actuación / Prevention of venous thromboembolism (VTE) in critically ill patients. Risk assessment and profilaxis protocol

Revisión sistemática de todos los elementos a tener en cuenta respecto al uso de los sistemas de compresión como terapia asociada a las heparinas en la prevención de la patología tromboembólica, y también como terapia "princeps" en aquellos enfermos con riesgo de sangrado o en los que el uso de fármacos para controlar dicha complicación está limitado(AU)

Systematic review of all elements to consider regarding the use of compression therapy systems associated with heparin in the prevention of thromboembolic disease, as well as therapy "princeps" in those patients at risk of bleeding or where the use of drugs to control this complication is limited(AU)

Claudicación intermitente como manifestación del síndrome de Pratesi / Intermittent claudication as a clinical expression of Pratesi's syndrome

El síndrome de Pratesi se caracteriza por la existencia de múltiples fístulas arteriovenosas en los miembros inferiores y por afectar preferentemente al varón durante la edad media de la vida. Clínicamente, cursa con claudicación intermitente bilateral en la pantorrilla, no progresiva, con períodos de remisión espontánea, asociada a frialdad subjetiva en los pies, con aumento real de la temperatura. No aparece dolor en reposo y no se asocia a trastornos tróficos.Presentamos el caso de un varón de 36 años con dolor en el gemelo interno del miembro inferior derecho, desde hacía años, que le impedía realizar esfuerzos continuos. La confirmación diagnóstica se realizó mediante estudio angiográfico, tratándose de manera conservadora. La presencia de múltiples comunicaciones arteriovenosas dificulta el tratamiento quirúrgico, resultando imposible ligarlas todas.El objetivo principal de la presentación de este caso clínico es describir las características clínicas de este síndrome y aportar un nuevo caso a los pocos referidos en la literatura médica revisada (AU)

The syndrome of Pratesi is characterised by the existence of multiple arteriovenous fistulas in lower members, which affect mainly men in their middle age. Clinically evolves with non progressive bilateral intermittent claudication in calf, with periods of spontaneous remission, associated to a subjective coldness in feet together with a real increase of temperature. No pain appears when at rest, and trophic disorders are not associated.AbstractWe present the case of a man of thirty-six with a pain in the inner gemellus of his right lower member. It has prevented him from making a continued effort for years. Diagnosis should be confirmed by means of angiographic study and the treatment was conservative. The present of multiples communication arteriovenous is difficult for the chirurgical treatment because it is impossible to joint them all. The main objective of this clinical case presentation is to describe the clinical characteristics of this syndrome and also provide a new case to the few reported in the literature reviewed (AU)

Contemporary issues in the prevention and management of postthrombotic syndrome.

OBJECTIVE: To provide an evidence-based review and clinical summary of postthrombotic syndrome (PTS). DATA SOURCES: A literature review was performed via MEDLINE (1950-July 1, 2009) and International Pharmaceutical Abstracts (1970-June 2009) searches using the terms post-thrombotic syndrome, post-phlebitic syndrome, deep vein thrombosis, and compression stockings. DATA SYNTHESIS: PTS is best characterized as a chronic syndrome of clinical signs and symptoms including pain, swelling, parasthesias, and ulceration in the affected limb following deep vein thrombosis (DVT). It occurs in up to half of patients with symptomatic DVT, usually within the first 2 years. Although the pathophysiology of PTS is not well understood, a thrombus may cause venous hypertension and valvular incompetence resulting in edema, tissue hypoxia, and in severe cases, ulceration. Risk factors for PTS include recurrent ipsilateral DVT, obesity, and poor quality of anticoagulant therapy. PTS diagnosis is based on the presence of typical signs and symptoms and may be made using one of several clinical scoring systems. Prevention of PTS should focus on DVT prevention and the use of elastic compression stockings following DVT, while fibrinolysis remains under investigation as an effective method for PTS prevention. The treatment of PTS may include either pharmacologic or mechanical modalities, although none of these regimens has been rigorously tested. Pharmacists have the opportunity to provide more comprehensive antithrombotic management by educating patients and providers on PTS, recommending appropriate preventive therapy, assisting patients in obtaining and adhering to this therapy, and assisting providers with the management of PTS. CONCLUSIONS: Providers should be proactive in preventing PTS, with pharmacists taking an active role in optimal DVT prevention, identifying patients at risk for PTS, and counseling and directing preventive therapies.