Department of Vascular Medicine, Montpellier University, Montpellier, France; EA2992, Montpellier University, Montpellier, France.
LIRMM, Montpellier University, Montpellier, France.
J Vasc Surg Venous Lymphat Disord. 2022 Jan;10(1):186-195.e25. doi: 10.1016/j.jvsv.2021.03.021. Epub 2021 May 6.
To determine the effects of graduated and progressive elastic compression stockings (ECS) on postural diameter changes and viscoelasticity of leg veins in healthy controls and in limbs with chronic venous disease (CVD).
In 57 patients whose legs presented with C, C, or C CEAP classes of chronic venous disease and were treated primarily with compression, and 54 healthy controls matched for age and body mass index, we recorded interface pressures (IFP) at 9 reference leg levels. Cross-sectional areas of the small saphenous vein (SSV) and a deep calf vein (DCV) were measured with B-mode ultrasound with patients supine and standing, recording the force (PF) applied on the ultrasound probe to collapse each vein with progressive ECS, and with and without graduated 15 to 20 mm Hg and 20 to 36 mm Hg elastic stockings. We chose these veins because they were free of detectable lesion and could be investigated at the same level (mid-height of the calf), and their compression by the ultrasound probe was not hampered by bone structures.
IFP decreased from ankle to knee with graduated 15 to 20 and 20 to 36 mm Hg, but increased with progressive ECS, and were 8.4 to 13.8 mm Hg lower for C than for control or C and C limbs. Without ECS, the SSV median [lower-upper quartile] cross-sectional area was 4.9 mm [3.6-7.1 mm] and 7.1 mm [3.0-9.9 mm] in C and C limbs versus 2.9 mm [1.8-5.2 mm] and 3.8 mm [2.1-5.4 mm] in controls (P < .01), respectively, while supine and standing. It remained greater in C and C than in C and control limbs wearing any ESC. Wearing compression, especially with progressive ECS, decreased the SSV and DCV cross-sectional area only with patients supine, thus decreasing postural changes, which remained highly diverse between individuals. The SSV cross-sectional area versus PF function traced a hysteresis loop of which the area, related to viscosity, was greater in C and C limbs than controls, even with graduated 15 to 20 or 20 to 36 mm Hg ECS. Progressive ECS decreased vein viscosity in the supine position, whereas 20 to 36 mm Hg and progressive ECS increased distensibility in the standing position.
ECS decrease the cross-sectional area of SSV and DCV with patients supine, but not upright. C limbs show distinctive features, especially regarding IFP. Graduated 20 to 36 mm Hg and progressive stockings lower viscosity and increase distensibility of the SSV.
确定分级和渐进弹性压缩袜（ECS）对健康对照者和慢性静脉疾病（CVD）肢体的体位直径变化和静脉粘弹性的影响。
在 57 名腿部出现 C、C 或 CCEAP 级慢性静脉疾病并主要接受压缩治疗的患者和 54 名年龄和体重指数匹配的健康对照者中，我们记录了 9 个参考腿部水平的界面压力（IFP）。使用 B 型超声测量小隐静脉（SSV）和小腿深部静脉（DCV）的横截面积，患者仰卧和站立，记录用渐进 ECS 对每个静脉施加的力（PF）以使其塌陷，并记录在没有分级 15 至 20 毫米汞柱和 20 至 36 毫米汞柱弹性袜的情况下。我们选择这些静脉是因为它们没有可检测到的病变，可以在同一水平（小腿中部）进行检查，并且它们不会因超声探头的压迫而受到骨骼结构的阻碍。
分级为 15 至 20 和 20 至 36 毫米汞柱的 ECS 会使 IFP 从脚踝到膝盖降低，但随着渐进式 ECS 的增加而增加，C 级的 IFP 比对照组或 C 和 C 级肢体低 8.4 至 13.8 毫米汞柱。没有 ECS 时，SSV 中位数[下四分位数-上四分位数]横截面积分别为 C 级和 C 级肢体的 4.9 [3.6-7.1 mm]和 7.1 [3.0-9.9 mm]，而对照组为 2.9 [1.8-5.2 mm]和 3.8 [2.1-5.4 mm]（P <.01），分别为仰卧位和站立位。在穿着任何 ESC 的 C 级和 C 级肢体中，它仍然大于 C 级和对照组。穿着压缩服，特别是穿着渐进式 ECS，仅在患者仰卧位时才会减小 SSV 和 DCV 横截面积，从而减小体位变化，而个体之间的变化仍然很大。SSV 横截面积与 PF 功能之间的关系追踪到一个滞后环，其中 C 级和 C 级肢体的面积与粘度有关，即使穿着分级为 15 至 20 或 20 至 36 毫米汞柱的 ECS，面积也大于对照组。渐进式 ECS 降低了仰卧位时 SSV 的粘度，而 20 至 36 毫米汞柱和渐进式 ECS 增加了站立位时的可扩张性。
ECS 会降低患者仰卧位时 SSV 和 DCV 的横截面积，但不会直立。C 级肢体表现出独特的特征，尤其是关于 IFP。分级为 20 至 36 毫米汞柱和渐进式压缩袜可降低 SSV 的粘度并增加其可扩张性。
