Does thigh compression improve venous hemodynamics in chronic venous insufficiency?

AbstractObjective: The aim of this study was to investigate the hemodynamic effects of thigh compression in patients with deep venous incompetence. Patients and Methods: This diagnostic test study was set in a municipal general hospital. Twelve patients with venous leg ulcers (CEAP classification, C6 Es Ad Pr; four men and eight women), with a mean age of 56.5 ± 16.8 years, with popliteal venous reflux of more than 1 second detected with duplex scan, underwent investigation with the following methods: 1, the pressure exerted under thigh-length compression stockings class II and short-stretch adhesive compression bandages was measured with an MST tester (Salzmann, Switzerland) and a CCS 1000 device (Juzo, Germany), respectively; 2, the great saphenous vein and the femoral vein on the thigh were compressed with a pneumatic cuff (0, 20, 40, and 60 mm Hg) containing a window through which the diameters of these veins could be measured with duplex ultrasonography; and 3, with the same thigh-cuff occlusion procedure, the venous filling index (VFI) for each experiment was measured with air plethysmography. These values reflected the presence and extent of venous reflux in each experiment depending on the degree of venous narrowing. Results: The mean pressure of a class II compression stocking was about 15 mm Hg at the thigh level, and adhesive bandages achieved a pressure of more than 40 mm Hg in the same location. A statistically significant reduction of the diameters of the great saphenous vein and the femoral vein could be obtained only when the cuff pressure on the thigh was equal to or higher than 40 mm Hg (P < .001). A reduction of the venous reflux (VFI) was achieved only with a thigh pressure of 60 mm Hg (P < .001). No significant reduction was seen of VFI with a thigh pressure in the range of the class II stockings. Previous investigations have shown that, in patients with deep venous incompetence, a pressure cuff on the thigh with 60 to 80 mm Hg is able to reduce ambulatory venous hypertension. Conclusion: Thigh compression as exerted with class II thigh-length compression stockings is not able to significantly reduce venous diameter or venous reflux. However, with a pressure of 40 to 60 mm Hg on the thigh that can be achieved with strongly applied short-stretch bandages, considerable hemodynamic improvement, including reduced venous reflux, can be obtained in patients with severe stages of chronic venous insufficiency from deep vein incompetence. The practical value of these preliminary findings should be investigated with further clinical trials. (J Vasc Surg 2002;36:948-52.