The well-manufactured and properly fitted compression stocking is the cornerstone of long-term treatment for chronic venous insufficiency. It allows most persons with serious venous reflux to perform upright activity while controlling symptoms and interrupting the otherwise steady progression of the disease. Symptoms are reduced and the quality of life improved even after 4 weeks of applying compression stockings . In a review of many randomized controlled trials, graduated pressure from ankle to calf was high effective in venous reflux disorders; the effect was most evident among those who must stand for prolonged times .
The effectiveness of compression stockings in reducing the signs and symptoms of venous insufficiency after deep vein thrombosis is determined by the time when the stockings are worn . Compliance, admittedly, is poor. A recent study revealed that only a third of patients with symptoms of venous insufficiency were using elastic compression stockings .
Studies of post-thrombotic sequelae in the legs demonstrated that the symptoms were decreased by about half with below-knee compression stockings . Recently, a meta-analysis study of compression stockings revealed convincing evidence that they limited swelling and reduced the likelihood of leg ulcers . Less convincing was evidence for preventing chronic venous insufficiency after an episode of deep vein thrombosis . It is assumed that proper fitting of compression hose was assured in all clinical trials.
The cost of an elastic stocking can be a serious problem for many individuals. As expected, the custom-fitted ones are costlier. Despite their considerable expense, the person with symptoms from venous insufficiency should appreciate that the properly performing compression stocking is a mechanical substitute for a disabled anti-gravitational system. In the long run, good care of the garment will extend its life considerably. The cost may be modest considering the potential burden of undertreated venous insufficiency.
Some medical insurance companies will cover the cost of therapeutic stockings, but the criteria for coverage are inconsistent at best. Other insurers, including Medicare, will not cover the stockings even though their proper use can greatly reduce the enormous expenses of disability, progression of the disease, and development of complications. Eventually, the proven benefit of therapeutic stockings may alter the position of third party payers.
Expect that the properly fitted and effective therapeutic stocking will become a life-time companion, just as a pair of glasses or hearing aid may become for some. Replacement is usually necessary every 3 or 4 months because the stress on the fibers gradually takes its toll, weakening the elastic force. Excessive pulling, rough wear, and harsh chemicals in washing can shorten the life of the stocking appreciably. Both finger and toenails should be kept short to prevent snagging the material and eventually cause unraveling.
THE COMPRESSION STOCKING: FITTING
Pressure-gradient stocking for control of venous valvular reflux must be prescribed ...