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Compression Therapy For Venous Disease >>   Back To Articles

Medical compression therapy to manage or prevent vascular disease

Compression therapy is the form of counter pressure against the natural down pressure exerted on the lower limbs when standing or sitting. In order for the compression stockings or bandaging to work, i.e. assist in the blood flow up the leg, it needs to be graduated with maximum pressure applied at the lower part of the limb, gradually reducing as it moves towards the heart:

Studies by Sigel (1975) and Kakkar (1980) have shown that the optimum compression profile for effective blood return is as follows:
Compression Therapy

It has been suggested that the ideal therapeutic pressure is 37mm Hg at the ankle. However, the best result is obtained from exerting the appropriate pressure. Higher pressure may be required for treatment, while lower pressures may be adequate for prevention. You need to balance comfort with the appropriate pressure requirement. A compression class system is used by manufacturers of compression stockings to indicate the pressure provided, with the most important measure being the pressure exerted at the ankle. The pressure is indicated in millimetres of Mercury (mm Hg) which is the pressure required to raise a column of Mercury to a given height:

Class I: 18 to 21mm Hg
  • For heaviness and fatigue in the leg
  • Initial varices during pregnancys

Class II: 23 to 31mm Hg
  • Relief of aching heaviness and fatigue caused by varices
  • Post sclerotherapy
  • Post surgical stripping
  • Prophylaxis of Thrombosis
  • Prophylaxis and treatment of complications of varicose veins and post phlebitic syndrome with chronic venous insufficiency
  • Varices during pregnancy
  • Pregnant patients with previous phlebitis
  • Control of oedema and effective scar formation after burns

Class III: 34 to 37mm Hg
  • Emphasized oedema from above causes
  • Correctiable lymphoedema
  • Severe chronic venous insufficiency as with post phlebitic syndrome
  • Chonic venous problems after surgery

Class IV: over 49 mm Hg
  • Primary and secondary Lymphoedema
  • Primary and secondary Elephantiasis

It is the opinion of many health care professional that “The most important thing a person can do to slow down the development of new varicose veins is to wear graduated compression support stockings as much as possible during the day.”

Where do flight socks fit into the stocking equation?

Flight socks provide light compression, typically below that of a class I compression stocking. They are better than nothing when travelling on long haul flights, but they are not properly fitted, being available in a very limited range of sizes, and they will not confer significant protection from deep vein thrombosis. The view of doctors is that, ideally, you should wear a class III compression stocking because that will provide the highest level of protection. In practice, you should aim to wear the highest class of stocking you are comfortable with and, as a minimum, a proper class I compression stocking. These are available in knee length as well as thigh length. Ensure that the stocking is properly fitted according to your leg measurements. Wear the stockings immediately prior to, during and for a while after your flight. Make sure you exercise your legs frequently during the flight by standing up and walking around. Minimise your alcohol intake and drink plenty of water, so that you maintain your blood volume and lower its viscosity.
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