Compression stockings (Flight Socks, Support Bandage) are a specialized hosiery designed to help prevent the occurrence of, and guard against further progression of, venous disorders such as

edema Edema (American English), also spelled oedema (British English), and also known as fluid retention, swelling, dropsy and hydropsy, is the build-up of fluid in the body's tissue (biology), tissue. Most commonly, the legs or arms are affected. S ...

phlebitis Phlebitis (or venitis) is inflammation of a vein, usually in the legs. It most commonly occurs in superficial veins. Phlebitis often occurs in conjunction with thrombosis (clotting inside blood vessels) and is then called thrombophlebitis or ...

and

thrombosis Thrombosis () is the formation of a Thrombus, blood clot inside a blood vessel, obstructing the flow of blood through the circulatory system. When a blood vessel (a vein or an artery) is injured, the body uses platelets (thrombocytes) and fib ...

. Compression stockings are elastic

compression garment Compression garments are pieces of clothing that fit tightly around the skin. In medical contexts, compression garments provide support for people who have to stand for long periods or have poor Circulatory system, circulation. These come in va ...

s worn around the leg, compressing the limb. This reduces the diameter of distended veins and increases venous blood flow velocity and valve effectiveness. Compression therapy helps decrease venous pressure, prevents venous stasis and impairments of venous walls, and relieves heavy and aching legs. Knee-high compression stockings are used not only to help increase circulation, but also to help prevent the formation of blood clots in the lower legs. They also aid in the treatment of ulcers of the lower legs. Unlike traditional dress or athletic stockings and socks, compression stockings use stronger elastics to create significant pressure on the legs, ankles and feet. Compression stockings are tightest at the ankles and gradually become less constrictive toward the knees and thighs. By compressing the surface veins, arteries and muscles, they force circulating blood through narrower channels. As a result, the arterial pressure is increased, which causes more blood to return to the heart and less blood to pool in the feet. There are two types of compression stockings, gradient and anti-embolism.

Medical uses

Treatment is usually prescribed by a physician to relieve all manifestations of chronic venous disease and prevent venous troubles. The use of elastic compression stockings can reduce volumetric variations during standing hours. Compression stockings are recommended under the following conditions:

Edema

Edema Edema (American English), also spelled oedema (British English), and also known as fluid retention, swelling, dropsy and hydropsy, is the build-up of fluid in the body's tissue (biology), tissue. Most commonly, the legs or arms are affected. S ...

is a condition where the opposing forces that occur in the small blood vessels and capillaries cause a net ultrafiltration of plasma water into the soft tissues.

Chronic venous insufficiency

Chronic peripheral venous insufficiency is when the veins cannot pump deoxygenated blood back to the heart.

Varicose veins

Varicose veins Varicose veins, also known as varicoses, are a medical condition in which superficial veins become enlarged and twisted. Although usually just a cosmetic ailment, in some cases they cause fatigue, pain, itch, itching, and cramp, nighttime leg cram ...

are saccular and distended veins which can expand considerably and may cause painful venous inflammation. Once developed, they will not disappear on their own. The formation of varicose veins is an externally visible sign of venous weakness. Many physicians and vein specialists recommend wearing compression stockings after varicose vein stripping, but studies show that wearing an elastic compression stocking has no additional benefit after the application of elastic bandaging for three days in post-operative care following the stripping of the

great saphenous vein The great saphenous vein (GSV; ) or long saphenous vein is a large, subcutaneous, superficial vein of the human leg, leg. It is the longest vein in the body, running along the length of the lower limb, returning blood from the foot, human leg, le ...

as assessed by control of limb, edema, pain, complications and return to work.

Deep vein thrombosis

Deep vein thrombosis Deep vein thrombosis (DVT) is a type of venous thrombosis involving the formation of a blood clot in a deep vein, most commonly in the legs or pelvis. A minority of DVTs occur in the arms. Symptoms can include pain, swelling, redness, and enl ...

occurs when blood flow decreases (especially in the lower extremities), causing blood to pool in the legs and leading to blood clot (thrombus) formation. Evidence does not suggest a benefit in

post thrombotic syndrome Post-thrombotic syndrome (PTS), also called postphlebitic syndrome and venous stress disorder is a medical condition that may occur as a long-term complication of deep vein thrombosis (DVT). Signs and symptoms Signs and symptoms of PTS in the le ...

rates following DVT. Compression stockings are beneficial in reducing symptomless deep vein thrombosis among airline passengers flying for 7 hours or more. Pharmacological (

warfarin Warfarin, sold under the brand name Coumadin among others. It is used as an anticoagulant, anticoagulant medication. It is commonly used to prevent deep vein thrombosis and pulmonary embolism, and to protect against stroke in people who ha ...

unfractionated heparin Heparin, also known as unfractionated heparin (UFH), is a medication and naturally occurring glycosaminoglycan. Heparin is a blood anticoagulant that increases the activity of antithrombin. It is used in the treatment of heart attacks and uns ...

, low molecular weight heparin) and mechanical measures (graded compression stockings, intermittent pneumatic compression devices, and venous foot pumps) are used to prevent

venous thromboembolism Venous thrombosis is the blockage of a vein caused by a thrombus (blood clot). A common form of venous thrombosis is deep vein thrombosis (DVT), when a blood clot forms in the deep veins. If a thrombus breaks off ( embolizes) and flows to the lun ...

(VTE) in clinical practice. For cases in which the bleeding risk is high and pharmacologic measures are contraindicated, the use of mechanical prophylaxis is recommended. Graduated compression stockings can effectively prevent VTE in hospitalized patients by applying different pressure to the leg. The meta-analysis of general surgical patients revealed that graduated compression stockings decreased their risk of developing VTE by 68% compared to placebo. Twenty randomized controlled trials analyzed the effectiveness of graduated compression stockings alone or with other additional prophylaxis in prevention of deep vein thrombosis. These trials included 1,681 patients after general surgery, orthopedic surgery, and medical patients. They concluded that graduated compression stockings are effective in deep vein thrombosis prophylaxis in patients who have undergone general and orthopedic surgery. Combining graduated compression stockings with other mechanical and pharmacological measures can increase the effectiveness of VTE prophylaxis by 60%. However, another study performed in France involved 407 ICU patients and showed no difference in the effectiveness of the VTE prevention for patients who used compression stockings alone or in combination with intermittent pneumatic devices.

Lymphedema

Lymphedema Lymphedema, also known as lymphoedema and lymphatic edema, is a condition of localized edema, swelling caused by a compromised lymphatic system. The lymphatic system functions as a critical portion of the body's immune system and returns inters ...

occurs when a body part swells due to an abnormal accumulation of lymph fluid, occurring when there is interference with the normal drainage of lymph fluid back into the blood, commonly swelling the arm, leg, neck or abdomen.

Phlebitis

Phlebitis Phlebitis (or venitis) is inflammation of a vein, usually in the legs. It most commonly occurs in superficial veins. Phlebitis often occurs in conjunction with thrombosis (clotting inside blood vessels) and is then called thrombophlebitis or ...

is the term used when inflammation and clotting occurs in a vein, most often a leg vein, due to infection, inflammation, or trauma. People with varicose veins are more often affected. Inflammation occurs suddenly, causing the thrombus to adhere firmly to the vein wall and risking clogging a superficial vein.

Lipodermatosclerosis

Lipodermatosclerosis Lipodermatosclerosis is a skin and connective tissue disease. It is a form of lower extremity panniculitis,Bruce AJ. et al., Lipodermatosclerosis: Review of cases evaluated at Mayo Clinic. J Am Acad Dermatol. 2002. an inflammation of the layer of ...

is the term used to refer to the inflammation of subcutaneous fat, a form of panniculitis.

Pregnancy

Hormones released during pregnancy and the expanding uterus (pressure on the inferior vena cava – the major vein returning blood up to the heart) can affect leg veins.

Postural orthostatic tachycardia syndrome (POTS)

The use of lower leg compression stockings has been found to reduce symptoms and heart rate when standing upright, in patients with

postural orthostatic tachycardia syndrome Postural orthostatic tachycardia syndrome (POTS) is a condition characterized by an abnormally large increase in heart rate upon sitting up or standing. POTS is a disorder of the autonomic nervous system that can lead to a variety of symptoms, ...

. Usage of compression garments on abdomen and thighs, and a combination of abdominal/thigh and leg covering compression was found to be more effective, with the latter having the most beneficial outcome.

Contraindications

Caution should be used in those with advanced peripheral obstructive arterial disease,

heart failure Heart failure (HF), also known as congestive heart failure (CHF), is a syndrome caused by an impairment in the heart's ability to Cardiac cycle, fill with and pump blood. Although symptoms vary based on which side of the heart is affected, HF ...

, septic phlebitis, oozing dermatitis and advanced peripheral neuropathy in regard to wearing compression stockings.

Procedure

Sizing

First the proper size stocking is determined by measuring the legs.

Aseptic technique Asepsis is the state of being free from disease-causing micro-organisms (such as pathogenic bacteria, viruses, pathogenic fungi, and parasites). There are two categories of asepsis: medical and surgical. The modern day notion of asepsis is deri ...

(antiseptic wound cleaning) is not necessary unless the skin is broken. The person is placed in the

supine position The supine position () means lying horizontally, with the face and torso facing up, as opposed to the prone position, which is face down. When used in surgical procedures, it grants access to the peritoneal, thoracic, and pericardium, pericardial ...

(lying down) in bed for fifteen minutes prior to measuring for fit. This allows for venous return and stability before measuring.

Application procedure

Stockings are best applied upon waking before the person has gotten out of bed, has been sitting or standing and before venous stasis or edema has had a chance to develop. The use of stockings for the entire day is more effective than just half the day or not using compression stockings at all. Fit is critical to the therapeutic effect of compression stockings. A study listed in the ''American Journal of Nursing in August'' 2008 showed that compression stockings were incorrectly sized in just under 30% of the cases studied. It found that additional education was needed not only for patients, but also for medical staff.

Gradient

These stockings are designed to remedy impaired "musculovenous pump" performance caused by incompetent leg vein valves. They are woven in such a way that the compression level is highest around the ankle and lessens towards the top of the hose. Doctors will typically recommend these stockings for those who are prone to blood clots, lower limb edema, and blood pooling in the legs and feet from prolonged periods of sitting or inactivity. They are also frequently used to address complications caused by

diabetes Diabetes mellitus, commonly known as diabetes, is a group of common endocrine diseases characterized by sustained high blood sugar levels. Diabetes is due to either the pancreas not producing enough of the hormone insulin, or the cells of th ...

lymphedema Lymphedema, also known as lymphoedema and lymphatic edema, is a condition of localized edema, swelling caused by a compromised lymphatic system. The lymphatic system functions as a critical portion of the body's immune system and returns inters ...

cellulitis Cellulitis is usually a bacterial infection involving the inner layers of the skin. It specifically affects the dermis and subcutaneous fat. Signs and symptoms include an area of redness which increases in size over a few days. The borders of ...

, and other conditions. They are worn by those who are ambulatory in most cases, helping calf muscles to perform their pumping action more efficiently to return blood to the heart. In some cases, they are worn by those at increased risk of circulatory problems, such as diabetics, whose legs are prone to excessive swelling. A common indicator for the prescription of such stockings is chronic peripheral venous insufficiency, caused by incompetent perforator veins. Low-pressure compression stockings are available without prescription in most countries, and may be purchased at a pharmacy or medical supply store. Stockings with a higher pressure gradient, say, above 25–30 mmHg, may require a prescription from a doctor. There are several crucial cautionary steps that need to be taken before using compression stockings: # A patient's

ankle brachial pressure index The ankle, the talocrural region or the jumping bone (informal) is the area where the foot and the leg meet. The ankle includes three joints: the ankle joint proper or talocrural joint, the subtalar joint, and the inferior tibiofibular joint. The ...

(ABPI) must be >1.0 per leg to wear compression stockings, otherwise the stockings may obstruct the patient's arterial flow. The ABPI indicates how unobstructed a patient's leg and arm arteries are. Any competent doctor or nurse can measure and calculate a patient's ABPI. # It is crucial that compression stockings are properly sized. The compression should gradually reduce from the highest compression at the smallest part of the ankle, until a 70% reduction of pressure just below the knee. Vascular doctors and nurses may use special pads to ensure uniform higher pressure around the circumference of the ankle (to smooth out the irregular cross-sectional profile.) Self-prescription is reasonably safe assuming that the compression gradient is 15–20 mmHg, the ABPI (for both legs) is >1.0 and that the stockings fit correctly. "Firm" gradient stockings (20–30 mmHg and 30–40 mmHg) should generally be worn only on medical advice. Current research reports mixed results of compression socks on athletic performance.

Knee-high versus thigh-high

Knee-high and thigh-high anti-embolism compression stockings

The graduated (gradient, graded) compression stockings and anti-embolism compression stockings come in knee-high and thigh-high length. A

meta-analysis Meta-analysis is a method of synthesis of quantitative data from multiple independent studies addressing a common research question. An important part of this method involves computing a combined effect size across all of the studies. As such, th ...

by Sajid et al. was done to compare knee-high and thigh-high graded compression stockings in regards of

deep vein thrombosis Deep vein thrombosis (DVT) is a type of venous thrombosis involving the formation of a blood clot in a deep vein, most commonly in the legs or pelvis. A minority of DVTs occur in the arms. Symptoms can include pain, swelling, redness, and enl ...

prevention in medical and surgical patients. The analysis determined that there was a 6% risk of developing deep vein thrombosis when wearing knee-high stockings and 4% when wearing thigh-high stockings, but also found significant heterogeneity, and thus it concluded that there is not enough evidence that one length is superior to the other, and suggests that knee-high compression stockings should be the first choice for the deep vein thrombosis prevention in medical and surgical patients. Knee-high stockings are more comfortable, easier to apply, and wearing them increases patients' compliance with treatment. Knee-high stockings are easier to size for limb measurement than thigh-high compression stockings. Thigh-high compression stockings may create a tourniquet effect and cause localized restriction when rolled down. A study of patients treated for

post-thrombotic syndrome Post-thrombotic syndrome (PTS), also called postphlebitic syndrome and venous stress disorder is a medical condition that may occur as a long-term complication of deep vein thrombosis (DVT). Signs and symptoms Signs and symptoms of PTS in the le ...

, performed in Italy, revealed that redness and itching of the skin was reported in 41% of patients wearing thigh-high and 27% in patients wearing knee-high compression stockings. Consequently, 22% of thigh-high wearers and 14% of knee-high wearers stopped the treatment.

Compression classes

Compression stockings are constructed using elastic fibers or rubber. These fibers help compress the limb, aiding in circulation. Compression stockings are offered in different levels of compression. The unit of measure used to classify the pressure of the stockings is

mmHg A millimetre of mercury is a manometric unit of pressure, formerly defined as the extra pressure generated by a column of mercury one millimetre high. Currently, it is defined as exactly , or approximately 1 torr = atmosphere = &nb ...

. They are often sold in a variety of pressure ranges.

History

Use of compression therapy is not new. As early as the

Neolithic period The Neolithic or New Stone Age (from Greek 'new' and 'stone') is an archaeological period, the final division of the Stone Age in Mesopotamia, Asia, Europe and Africa (c. 10,000 BCE to c. 2,000 BCE). It saw the Neolithic Revolution, a wid ...

(5000-2500 BCE), images of soldiers with bandaged lower extremities were found in the drawings of the caves of Tassili in Sahara. The

Edwin Smith Papyrus The Edwin Smith Papyrus is an ancient Egyptian medical manual, medical text, named after Edwin Smith (Egyptologist), Edwin Smith who bought it in 1862, and the oldest known surgical treatise on trauma (medicine), trauma. This document, which ma ...

, which dates to roughly 1600 BCE, included additional evidence of mechanical compression therapy for legs.

Hippocrates Hippocrates of Kos (; ; ), also known as Hippocrates II, was a Greek physician and philosopher of the Classical Greece, classical period who is considered one of the most outstanding figures in the history of medicine. He is traditionally referr ...

treated his patients' leg ulcers with tight bandages, which were described in his ''

Corpus Hippocraticum The Hippocratic Corpus (Latin: ''Corpus Hippocraticum''), or Hippocratic Collection, is a collection of around 60 early Ancient Greek medical works strongly associated with the physician Hippocrates and his teachings. The Hippocratic Corpus cove ...

'' (450–350 BCE).

Galen Aelius Galenus or Claudius Galenus (; September 129 – AD), often Anglicization, anglicized as Galen () or Galen of Pergamon, was a Ancient Rome, Roman and Greeks, Greek physician, surgeon, and Philosophy, philosopher. Considered to be one o ...

(130-200 CE) used wool and linen compression bandages to prevent blood from pooling in the legs, and Oribassius (324 CE) would use tight bandages to treat leg ulcers. During the

Middle Ages In the history of Europe, the Middle Ages or medieval period lasted approximately from the 5th to the late 15th centuries, similarly to the post-classical period of global history. It began with the fall of the Western Roman Empire and ...

, the leading use of leg compression bandages was mainly for therapy. This is evidenced by the works of

Avicenna Ibn Sina ( – 22 June 1037), commonly known in the West as Avicenna ( ), was a preeminent philosopher and physician of the Muslim world, flourishing during the Islamic Golden Age, serving in the courts of various Iranian peoples, Iranian ...

(980–1037); Giovanni Michele Savonarola (1384–1468);

Ambroise Paré Ambroise Paré (; – 20 December 1590) was a French barber surgeon who served in that role for kings Henry II, Francis II, Charles IX and Henry III. He is considered one of the fathers of surgery and modern forensic pathology and a pione ...

(1510–1590); Girolamo Fabrizio di Acquapendente (1537–1619); and other scientists.

Guy de Chauliac Guy de Chauliac (), also called Guido or Guigo de Cauliaco ( – 25 July 1368), was a French physician and surgeon who wrote a lengthy and influential treatise on surgery in Latin, titled '' Chirurgia Magna''. It was translated into many other la ...

in his book '' Chirurgica Magna'' described the use of compression bandages to treat enlarged veins of the legs. Giovanni Michele Savonarola also treated varicose veins with the help of the leg bandages and described their proper application in his work ''Practice''. In 1628,

William Harvey William Harvey (1 April 1578 – 3 June 1657) was an English physician who made influential contributions to anatomy and physiology. He was the first known physician to describe completely, and in detail, pulmonary and systemic circulation ...

discovered the link between

venous stasis Venous stasis, or venostasis, is a condition of slow blood flow in the veins, usually of the legs. Presentation Complications Potential complications of venous stasis are: * Venous ulcers * Blood clot formation in veins (venous thrombosis), tha ...

and the external pressure. Following that discovery, various compression measures were introduced for therapy: laced stockings, elastic bands, and tight bandages with resin. Later, new textile materials started to be used for the production of compression stockings: natural or cellulose fibers (silk, cotton, coconut) and chemical (acrylic, nylon, polyester). It was only at the end of the 19th century, after Fisher and Lasker, German

phlebologist Phlebology is a medical speciality that is concerned with venous issues including the diagnosis and treatment of disorders of the veins. A medical specialist in this field is known as a phlebologist. The specialty of phlebology has developed to e ...

s, discovered that the application of the external pressure helped to treat blood clots in the lower extremities, that compression stockings started to be used for the treatment of

Society and culture

Commonly used terms

*''Anti-embolism'' – Worn by non-ambulatory or post-surgical patients to help prevent pooling of blood in the legs that could lead to a

venous thrombosis Venous thrombosis is the blockage of a vein caused by a thrombus (blood clot). A common form of venous thrombosis is deep vein thrombosis (DVT), when a blood clot forms in the deep veins. If a thrombus breaks off ( embolizes) and flows to the lu ...

. *''Custom'' – Made for a specific individual. *''Circular knit'' – Seamless stockings that offer greater aesthetic appeal. *''Flat knit'' – Stockings made with a seam that can be constructed in virtually any shape or size. Most often used in higher compression classes. *''Silver'' – Stockings constructed using special silver textile fibers.

Silver Silver is a chemical element; it has Symbol (chemistry), symbol Ag () and atomic number 47. A soft, whitish-gray, lustrous transition metal, it exhibits the highest electrical conductivity, thermal conductivity, and reflectivity of any metal. ...

has an anti-microbial effect, helping to reduce odor. *''Lymphedema'' – Stockings used to manage

resulting from the onset of

. *''Support'' – Mild compression stockings sold over-the-counter and without a physician's prescription. These stockings are commonly referred to as TED hose, short for thromboembolism-deterrent hose. They are used to support the venous and lymphatic drainage of the leg.

Economy class stroke syndrome

There is a possible link between a common physical defect in the heart and potentially deadly

stroke Stroke is a medical condition in which poor cerebral circulation, blood flow to a part of the brain causes cell death. There are two main types of stroke: brain ischemia, ischemic, due to lack of blood flow, and intracranial hemorrhage, hemor ...

that could occur during long aeroplane flights. The connection, called "economy class stroke syndrome," has been reported in healthy, young travelers who had ischemic strokes during or shortly after long air trips. Prolonged sitting associated with air travel is known to be a cause of clots in the legs. Upward of 30 percent of the population is estimated to have

patent foramen ovale Atrial septal defect (ASD) is a congenital heart defect in which blood flows between the atria (upper chambers) of the heart. Some flow is a normal condition both pre-birth and immediately post-birth via the foramen ovale; however, when this d ...

(PFO), a common condition where a small hole exists between the right and left sides of the heart. PFO rarely causes any adverse medical condition and can be determined only through specific diagnostic tests such as an echocardiogram.

Styles

* Knee-high compression, closed toe for men * Thigh-high (AG) * Pantyhose (AT) * Maternity pantyhose * Waist attachment/CHAPS

References

{{Authority control Clothing by function Hosiery