The Benefits of Compression Therapywith Medical Stockings

Chronic Venous Disorders; a problematic but manageable condition with gradient compression therapy

Edema

Reticular Veins

Varicose Veins

Venous Ulcer

Chronic Venous Disorders Clinical Studies

Demographicsn It is estimated that 20 % of men and 30 % of women suffer from some form of venous disorder

n Peak incidence occurs in women aged 40-49 years and men aged 70-79 years

Risk Factors n Increased age

n Prior deep vein thrombosis (DVT)

n Sedentary lifestyle

n History of leg trauma

n Obesity

n Cardiac disease

n Multiple pregnancies

n Family history of DVT

Pathophysiology n Incompetent valves

n Reflux with or without residual obstruction

n Ambulatory venous hypertension

n Increased venous pressure transmitted to the capillaries

n Increased pressure in the capillaries of the skin

n Chronic swelling and skin changes

Clinical Manifestationsn Varicose veins

n Leg pain

n Distal leg edema

n Induration

n Skin pigmentation

n Stasis dermatitis

n Ulceration

Podnos, Y. Chronic Venous Insufficiency. eMedecine Journal. 2001;2(11).

Chronic Venous DisordersClinical Studies

1) Compression Stocking for Chronic Venous Insufficiency (CVI)

Methodologyn 112 CVI patients; all non-compression stocking wearersn Seven symptoms were rated on a five-point scalen Patients then wore 30-40 mmHg gradient compression stockings

n Symptoms were re-rated at 1 and 16 months

Conclusion n Patients reported a significant reduction (p<0.001) in severity scores for the symptoms rated including swelling, pain, skin discoloration, depression, sleep problems and cosmetic problems, with a significant increase in activity tolerance at one monthn At 16 months, even more favorable scores were reported

n After 16 months, 70 % of patients were still wearing compression stockings

2) Compression Stockings for Venous Ulcers

Methodologyn Retrospective studyn 119 patients with severe CVI were evaluated, however, six were excluded due to death, amputation, etc.n 89 % of patients fitted with 30-40 mmHg knee-length stockings, 7 % wore 30-40 mmHg thigh-length stockings, 2 % wore 40-50 mmHg knee-length stockings and 2 % wore 20-30 mmHg knee-length stockings

Conclusion - Venous Ulcer Patientsn 102 of 113 patients (90 %) were compliant with stockings

n Complete ulcer healing occurred in 99 of 102 compliant patients (97 %) and only 6 of 11 non-compliant patients (55 %)

Results

Mean time to complete ulcer healing in 99 compliant patients was 4.8 months versus 13.8 months for the 6 non compliant patients whose ulcers healed

Conclusion - Venous Ulcer Recurrencen Information was available on 73 of 105 patients (70 %) who experienced complete ulcer healingn 58 of 73 patients (79 %) remained compliant with compression stockings; venous ulceration recurred in 22 % within 36 months in this group

n 15 of 73 patients (21 %) were non compliant; venous ulceration recurred in 100 % within 36 months

Motykie GD, Caprini JA, Arcelus JI, et al. Evaluation of therapeutic compression stockings in the treatment of chronic venous insufficiency. Dermatol Surg. 1999;25:116-120. Mayberry JC, Moneta GL, et al. Fifteen-year results of ambulatory compression therapy for chronic venous ulcers. Surgery. 1991;109:575-81.

15 Year Results of Compression Therapy for Chronic Venous Ulcers8

STUDY OBJECTIVETo document the healing percentage and long-term recurrence rate of venous ulcers when applying compression therapy

METHODOLOGYRetrospective study119 patients with severe CVI were evaluated, however, six were excluded due to death,amputation, etc.89% of patients fitted with 30-40 mmHg knee-length stockings, 7% wore 30-40 mmHg thigh-length stockings, 2% wore 40-50 mmHg knee-length stockings and 2% wore 20-30 mmHg knee-length stockings

CONCLUSIONS - VENOUS ULCER PATIENTS102 of 113 patients (90%) were compliant with stockingsComplete ulcer healing occurred in 99 of 102 compliant patients (97%) andonly 6 of 11 non-compliant patients (55%)

RESULTS

BSN-JOBST, Inc.5825 Carnegie Blvd., Charlotte, NC 28209-4633PO Box 471048, Charlotte, NC 28247-1048 U.S.A.To order toll free: 1-800-537-1063Tel. 704-554-9933 Fax 1-800-835-4325Fax for international use: 704-551-7173www.jobst.com

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93% of 113 patients achieved complete ulcer healingin a mean of 5.3 months. 96% of patients wore 30-40 mmHg kneelength or thigh length stockings.

4.8monthsCompliant Noncompliant Patients Patients

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Mean time to complete ulcer healing in 99 compliant patients was 4.8 months versus 13.8 monthsfor the 6 noncompliant patients whose ulcers healed

CONCLUSIONS - VENOUS ULCER RECURRENCEInformation was available on 73 of 105 patients (70%) who experienced complete ulcer healing58 of 73 patients (79%) remained compliant with compression stockings; venous ulceration recurred in 22% within 36 months in this group15 of 73 patients (21%) were noncompliant; venous ulceration recurred in 100% within 36 months

8. Mayberry JC, Moneta GL, et al. Fifteen-year results of ambulatory compression therapy for chronic venous ulcers. Surgery. 1991;109:578-81

Comfort, Health and Style!

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Compliant Patients

Non Compliant Patients

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Chronic Venous Disorders Clinical Studies

3) Compression Stockings to Prevent Post-Thrombotic Syndrome (PTS)n PTS is a chronic condition characterized by leg swelling, pain, edema after a deep vein thrombosis, venous ectasia, and skin induration

n PTS is caused by venous hypertension, which results in chronic pain and swelling

n After an episode of deep vein thrombosis, 20 % to 50 % of patients develop PTS within the first 2 years

n PTS can be permanently disabling, accounting for 2 million work days lost annually in the United States

Methodologyn Randomized, controlled trial

n 180 patients with proximal DVT who received conventional anticoagulant treatment, were randomly assigned to wear (90 patients), or not wear (90 patients), below-knee compression stockings for 2 years

n 6 patients withdrew from the study, 5 due to itching, redness or discomfort caused by the stockings and 1 due to difficulty with putting the stockings on

n Examinations occurred at 3 and 6 months, and every 6 months after that. Although there was some follow-up for 5 years, there was a significant drop off in the number of patients from year 3 onwards. So the author only reported data up to 2 years

n Ready-to-wear compression stockings to prevent Post-Thrombotic Syndrome

n Post-thrombotic symptoms: pain, cramps, heaviness, pruritus, and paresthesia, were scored

n Post-thrombotic objective signs: pretibial edema, skin induration, hyperpigmentation, new venous ectasia, redness, and pain during calf compression, were scored

Conclusion

Cumulative Incidence of PTS

Patient Group 6 months 1 year 2 years Without Compression Stockings (90) 40.0 % 46.7 % 49.1 % With Compression Stockings (90) 21.1 % 22.2 % 24.5 %

n Post-thrombotic sequelae developed in 44 of 90 patients not wearing compression stockings

n Post-thrombotic sequelae developed in 23 of 90 patients wearing compression stockings

n Anticoagulant treatment alone is unlikely to affect the development of late post-thrombotic sequelae

JOBST® - a brand of

Prandoni P, Lensing AWA, Prins MH, Frulla M, Marchiori A, Barnardi E, Tormene D, Mosena A: “Below-Knee Elastic Compression Stockings To Prevent the Post-Thrombotic Syndrome. A Randomized, Controlled Trial”. Annales of Internal Medicine, 2004, 141:249-256.

Hirsh J, Hoak J: Management of deep vein thrombosis and pulmonary embolism. A statement for healthcare professionals. Council on Thrombosis (in consultation with the Council on Cardiovascular Radiology), American Heart Association. Circulation.1996, 93:2212-2245.

Motykie GD, Caprini JA, Arcelus JI, Reyna JJ, Overom E, Mokhtee D: Evaluation of therapeutic compression stockings in the treatment of chronic venous insufficiency. Dermatol Surg 1999, 25:116-20.

Khan SR, Hirsch A, Shrier I, “Effect of Postthrombotic Syndrome on Health-Related Quality of Life After Deep Vein Thrombosis”, Arc Intern Med 2002; 162:1144-1148.