Faculty of Medicine, University of Cambridge, Cambridge, UK.
Academic Section of Vascular Surgery, Imperial College London, London, UK.
Eur J Vasc Endovasc Surg. 2018 Mar;55(3):406-416. doi: 10.1016/j.ejvs.2017.11.025. Epub 2018 Jan 9.
Compression stockings are commonly prescribed for patients with a range of venous disorders, but are difficult to don and uncomfortable to wear. This study aimed to investigate compliance and complications of compression stockings in patients with chronic venous disease (CVD) and post-thrombotic syndrome (PTS).
A literature search of the following databases was carried out: MEDLINE (via PubMed), EMBASE (via OvidSP, 1974 to present), and CINAHL (via EBSCOhost). Studies evaluating the use of compression stockings in patients with CVD (CEAP C2-C5) or for the prevention or treatment of PTS were included. After scrutinising full text articles, compliance with compression and associated complications were assessed. Compliance rates were compared based on study type and degree of compression. Good compliance was defined as patients wearing compression stockings for >50% of the time.
From an initial search result of 4303 articles, 58 clinical studies (37 randomised trials and 21 prospective studies) were selected. A total of 10,245 limbs were included, with compression ranging from 15 to 40 mmHg (not stated in 12 studies) and a median follow-up of 12 months (range 1-60 months). In 19 cohorts, compliance was not assessed and in a further nine, compliance was poorly specified. Overall, good compliance with compression was reported for 5371 out of 8104 (66.2%) patients. The mean compliance, weighted by study size, appeared to be greater for compression ≤25 mmHg (77%) versus > 25 mmHg (65%) and greater in the randomised studies (74%) than in prospective observational studies (64%). Complications of stockings were not mentioned in 43 out of 62 cohorts reviewed. Where complications were considered, skin irritation was a common event.
In published trials, good compliance with compression is reported in around two thirds of patients, with inferior compliance in those given higher degrees of compression. Further studies are required to identify predictors of non-compliance, to help inform the clinical management of these patients. Complications of compression are not documented in many studies and should be given more consideration in the future.
压缩袜常用于治疗各种静脉疾病患者，但穿着困难且不适。本研究旨在调查慢性静脉疾病（CVD）和血栓后综合征（PTS）患者使用压缩袜的依从性和并发症。
对以下数据库进行文献检索：MEDLINE（通过 PubMed）、EMBASE（通过 OvidSP，1974 年至今）和 CINAHL（通过 EBSCOhost）。纳入评估 CVD（CEAP C2-C5）患者使用压缩袜或预防或治疗 PTS 患者使用压缩袜的研究。在仔细审查全文文章后，评估了对压缩的依从性和相关并发症。根据研究类型和压缩程度比较了依从率。定义良好的依从性为患者每天穿着压缩袜的时间超过 50%。
最初检索到 4303 篇文章，其中 58 项临床研究（37 项随机试验和 21 项前瞻性研究）入选。共纳入 10245 条肢体，压缩范围为 15-40mmHg（12 项研究未报告），中位随访时间为 12 个月（范围 1-60 个月）。19 项队列研究未评估依从性，另外 9 项研究未明确规定依从性。总体而言，8104 名患者中有 5371 名（66.2%）报告了良好的压缩依从性。按研究规模加权的平均依从率，<25mmHg 的压缩组（77%）明显高于>25mmHg 的压缩组（65%），随机研究组（74%）明显高于前瞻性观察研究组（64%）。62 项研究中，43 项未提及袜子并发症。在考虑并发症的研究中，皮肤刺激是常见事件。
在已发表的试验中，约三分之二的患者报告了良好的压缩依从性，给予较高程度压缩的患者依从性较差。需要进一步研究以确定不依从的预测因素，以帮助为这些患者的临床管理提供信息。许多研究未记录压缩并发症，未来应更加重视这些并发症。
