Inelastic versus elastic leg compression in chronic venous insufficiency: a comparison of limb size and venous hemodynamics.

PURPOSE

Compression of the lower extremity is the mainstay of therapy in patients who have chronic venous insufficiency. We evaluated the ability of two forms of compression-elastic stockings and an inelastic compression garment-with air plethysmography to determine how well they corrected abnormal deep venous hemodynamics in patients who had class III chronic venous insufficiency and how well this correction was sustained over time.

METHODS

Patients had measurements taken with no compression, with a 30 to 40 mm Hg below-knee stocking, and with the inelastic compression garment 2 hours and 6 hours after donning the garments. Therapies were compared with baseline and with themselves over time.

RESULTS

Inelastic compression maintained limb size and reduced venous volume better than no compression or stockings over time (ankle circumference at 2 hr vs 6 hr: baseline, 24.7 +/- 7 cm vs 26.1 +/- 1.1 cm; stocking, 23.9 +/- 1.1 cm vs 26.2 +/- 1.2 cm; inelastic compression, 25.4 +/- 1.1 cm vs 25.4 +/- 0.9 cm; venous volume at 2 hr vs 6 hr: baseline, 97.5 +/- 14.1 ml vs 105.2 +/- 17.9 ml; stocking, 112.4 +/- 29.7 ml vs 77.5 +/- 13.2 ml; inelastic compression, 72.2 +/- 14.1 ml vs 56.1 +/- 10.2 ml). At 6 hours, the ejection fraction was increased and the venous filling index was significantly less with inelastic compression compared with the stocking and baseline (ejection fraction at 6 hr: baseline, 61.6% +/- 6.9%; stocking, 75.9% +/- 17.7%; inelastic compression, 78.8% +/- 12.2%).

CONCLUSIONS

Inelastic compression has a significant effect on deep venous hemodynamics by decreasing venous reflux and improving calf muscle pump function when compared with compression stockings, which may exert their primary effect on the superficial venous system.