Phlebology: The Journal of Venous Disease

To evaluate the influence of minimal-stretch and elasticated bandages on calf muscle pump function in patients with chronic venous disease.

An open, randomised, crossover study.

University Department of Surgery, Fremantle Hospital, Perth, Australia.

Twenty patients with chronic venous disease and recently healed chronic venous ulcers.

Five different bandaging regimens were applied on each patient, and calf muscle pump function was assessed by using air plethysmography.

There was no significant difference in the venous filling index (VFI) and ejection fraction (EF) between the five different bandage regimens, and also no significant difference in four of the five bandage regimens over a 7-day period (p>0.05). However, the VFI was significantly reduced and the EF was not significantly altered after the application of both elasticated and minimal-stretch bandages (p<0.05, = p>0.05 respectively).

All the bandage regimens used in this study have a similar influence on calf muscle pump function, and may therefore have a similar effect on the healing of chronic venous ulcers.

TED antiembolism stockings, Panelast self-adhesive elasticated bandages and Medi Plus class II stockings are three different dressings commonly used to provide compression following surgery for varicose veins. The aim of this study was to determine which of the three dressings was most acceptable to patients.

Forty-two patients undergoing bilateral varicose vein surgery were randomised to receive a different dressing on each leg in order to determine if a particular type of dressing was superior in its ability to reduce postoperative pain and provide adequate comfort without reducing mobility. The dressings were worn for 1 week, during which daily pain scores were recorded for each leg followed by a simple questionnaire to determine comfort and mobility.

There was a significant reduction of mobility experienced by patients wearing Panelast bandages compared with the other two dressings (p<0.05). However, there were no significant differences between the dressings with regard to the degree of postoperative pain experienced, and in all other respects the dressings were equally tolerated.

The choice of compression dressings used for varicose vein surgery should depend primarily on the personal preference of surgeons as well as financial considerations.

Investigation of the effects of high- and low-ankle-pressure, above- and below-knee compression stockings on the haemodynamics of normal and superficially incompetent venous systems.

Prospective duplex study of a normal group and a venous incompetence group randomised to high- or low-pressure stockings.

Vascular services of a University Hospital.

Six subjects with normal venous haemodynamics (12 limbs) and 12 patients with superficial venous incompetence (20 limbs).

Subjects wore below-knee and then above-knee stockings for 1 week each. Duplex scans were performed at the outset and end of the study and on fitting and after wearing each stocking type.

Duplex-derived femoral and popliteal venous velocities were measured and indexed against the initial velocity.

Below-knee stockings produced only minor changes. Above-knee stockings produced increased velocities in normal subjects. Similar changes were only seen with higher-pressure stockings in patients with incompetence.

Above-knee, high-ankle-pressure stockings produce increased deep venous flow velocities.

To assess the physiological effect of low-pressure graded compression stockings (GCS) on the blood flow of the lower limb with the use of colour Doppler.

A randomised controlled study.

X-ray Department in a teaching hospital.

Forty-five healthy, adult, voluntary subjects.

Subjects were randomised into three groups to either wear thigh- or knee-length GCS of the same type or no stockings. The diameter and cross-sectional area of the femoral and popliteal veins and the peak venous velocities were measured with colour Doppler before the application of GCS and after 20 min bed rest with the stockings in situ.

Measurements showed a significant increase of the peak velocity in the femoral vein with thigh-length GCS (p<0.002). There was a significant decrease of the popliteal vein diameter and cross-sectional area with thigh-length GCS (p<0.05). There was no significant change in the knee-length GCS group and the control group, in which patients did not wear stockings. A paired t-test was used to determine the significance of the changes.

Thigh-length GCS have an effect of increasing venous peak velocity in the femoral vein, hence decreasing venous stasis. Furthermore, they decrease the dilatation of the popliteal vein, which may reduce the risk of intimal tears occurring, which may contribute to venous thrombogenesis. Other methods can given more information in assessing the effect of various lengths of stocking on venous stasis.

It is often recommended that patients should wear compression stockings for 6 weeks after varicose vein surgery. The aim of this trial was to ascertain whether this is necessary.

Following a standardised operation for primary varicose veins, patients were randomised to receive postoperative compression with either Panelast Acryl adhesive short-stretch bandages for 1 week or crepe bandages for 16 h followed by 6 weeks wearing of TED antiembolic stockings. Symptoms were quantified by questionnaire and clinical assessment at 1 and 6 weeks.

Postoperatively there was significantly more bleeding in the crepe/TED group and a larger area of bruising at the end of the first week (117.5 cm² vs. 96 cm², p<0.02; Mann–Whitney U-test). However, this did not correlate with any difference in discomfort or activity between the two groups. There was no statistical difference in the symptoms reported after the first week. Twenty-seven patients out of 52 randomised to TEDs discarded them before the end of the 6 weeks. Both groups returned to full activities and work after similar periods (Panelast 18.5 days vs. crepe 20.0 days).

There was no benefit in wearing compression for more than 1 week. Wearing Panelast bandages for the first week did significantly reduce pain on the first postoperative day, bleeding and the extent of bruising.

To evaluate the incidence and associated problems of common peroneal nerve (CPN) injury, which can occur during short saphenous vein (SSV) surgery.

A retrospective cohort study.

Section of Vascular Surgery in a University Hospital.

In a consecutive series of 88 patients (31 male, 57 female, ages ranging from 35 to 68 years, mean 49), 104 lower extremities were operated on for SSV insufficiency.

Each patient was assessed by clinical examination, duplex scanning and in some cases by venography (ascending venography and/or varicography). Surgery was carried out via a longitudinal or transverse approach in the popliteal region or the posterior aspect of the thigh.

Haemodynamic criteria, cosmetic outcome and complications of the surgical procedures due to SSV insufficiency were considered. In particular, we focused on neurological complications.

Abnormality of foot dorsiflexion was observed in two out of 104 (2%) cases. This complication was caused by injury to the CPN. Recovery had occurred 1 year later.

Two factors seem to be essential in preventing this neurological complication: (a) good knowledge of surgical anatomy and (b) a cautious, accurate surgical technique. The incidence of this complication has been underestimated, but its importance and medico-legal implications must be emphasised.

To study the anatomical distribution of chronic venous insufficiency (CVI) in a Chinese population by means of duplex scanning.

A total of 582 limbs in 291 patients with primary venous insufficiency were classified clinically into three different groups according to SVS/ISCVS criteria and evaluated prospectively with duplex scanning.

One hundred and thirty-one limbs were classified into group I (CEAP clinical class 0), 291 into group II (CEAP clinical classes 1 and 2) and 160 into group III (CEAP clinical classes 3–6). Mixed deep and superficial venous incompetence was found in 70% and 83% of limbs in groups II and III, respectively. Reflux was also demonstrated in 73% of group I limbs.

Most of our patients had mixed deep and superficial venous incompetence. The prevalence of deep venous incompetence in this population, in which deep vein thrombosis is rare, suggests a pattern of venous incompetence other than postphlebitic deep vein valvular dysfunction. The prevalence of reflux in the asymptomatic contralateral limbs implies a bilateral predisposition to venous reflux and thus a possible developmental origin of CVI.

Follow-up studies of deep venous thrombosis (DVT) are needed to gain increased knowledge of the process of recanalisation over time. In this study modern diagnostic techniques were used to analyse changes in venous circulation during the process of recanalisation and thrombus resolution.

Prospective follow-up study of patients with symptomatic DVT referred to a vascular diagnostic laboratory. The patients were evaluated by repeated examinations with colour duplex ultrasound and computerised strain-gauge plethysmography.

Eighteen consecutive patients with acute DVT occluding the calf veins and femoropopliteal vein segments.

Ultrasonographic assessment of thrombus resolution and flow patterns in deep and superficial veins. Plethysmographic determination of venous volume and venous outflow capacity.

At 3 months' and 6 months' follow-up, 33% and 56%, respectively, were recanalised but almost all limbs still had some degree of functional outflow obstruction. Duplex evaluation further demonstrated a complex pattern of recanalisation with thrombus resolution from above, from below or both. Computerised strain-gauge plethysmography showed a progressive time-related increase in venous outflow capacity and venous volume over 6 months, but volumetric variables could not be used to distinguish between limbs with patent veins and those with still-occluded veins. None of the limbs had completely compressible femoropopliteal venous segments at the end of the follow-up.

The combination of these two modern diagnostic techniques, suitable for repeated studies, can provide detailed information on morphological and haemodynamic changes occurring during the process of recanalisation and thrombus resolution.