Compression therapy

Physical treatment method for diseases of the veins and lymphatic vessels and other oedema diseases. A distinction is made between a decongestion and maintenance phase.

In the decongestion phase, bandage systems that have to be adapted again and again (e.g. short-stretch bandages with padding, multi-component ready-made systems or wrap bandages) are used. Compression stocking supplies have proven to be effective in the maintenance phase.

Effect on the leg:

• Increased fibrinolytic activity.
• Decrease of the pendulum flow in superficial varices.
• Decrease of the increased intravascular blood volume, increase of the flow velocity.
• Decrease of extracellular infiltrated edema or decrease of tissue pressure in the compressed leg, increase of the return transport of tissue fluid.
• Anti-inflammatory properties on the venous wall.
• Reduction of pain.

Notice! Before applying medical compression therapy, the arterial situation of the foot and/or big toe arteries should be checked. The systolic pressure measured above the anterior, posterior and dorsal arteries should be at least 60 mmHg, the pressure at the big toe arteries at least 30 mmHg. CAVE: false high values in case of mediasclerosis e.g. in the context of diabetes mellitus! Clinical signs of critical ischemia such as resting pain or acral ulcerations are an absolute contraindication for medial compression therapy.

Varicosis:

• Varicosis primary and secondary
• Varices during pregnancy
• Support of the sclerotherapy
• after venous surgery.

Thromboembolism:

• Thrombophlebitis (superficial) and condition after healed phlebitis
• deep vein thrombosis
• Condition after thrombosis
• postthrombotic syndrome
• Thrombosis prophylaxis for mobile patients.

Chronic venous insufficiency (CVI):

• CVI of stages I to III according to Widmer or C1S-C6 according to CEAP classification
• Ulcer prevention and ulcer therapy
• Guiding vein insufficiency
• Angiodysplasia.

Edema:

• Lymphedema
• edema during pregnancy
• post-traumatic edemas
• postoperative oedemas
• cyclic idiopathic edema
• Lipedema from stage II
• Congestion due to immobility (arthrogenic congestion syndrome, paresis and partial paresis of the limb).

Other indications:

• Condition after burns
• Scar treatment.

Notice! A compression bandage can improve an edematous condition, a compression stocking can maintain a condition!

For modern compression therapy, various materials are now available:

• Thrombosis prophylaxis stocking (designed for the lying patient)
• Compression bandage - with short stretch bandages, long stretch bandages, with/ without padding
• Finished compression bandage systems
• medical compression stockings - class I-IV, round/flat knitted material, different elasticity
• Ulcer compression stockings
• adaptive compression bandaging systems so-called wrap bandages
• intermittent mechanical pneumatic compression therapy

The only exception to this are non-medically standardized compression products: travel compression stockings, sports compression stockings and so-called support stockings.

Notice! Before applying medical compression therapy, the arterial situation of the foot and/or big toe arteries should be checked. The systolic pressure measured above the anterior, posterior and dorsal arteries should be at least 60 mmHg, the pressure at the big toe arteries at least 30 mmHg. CAVE: false high values in case of mediasclerosis e.g. in the context of diabetes mellitus! Clinical signs of critical ischemia such as resting pain or acral ulcerations are an absolute contraindication for medial compression therapy.

Advanced AVC, decompensated heart failure, septic phlebitis, phlegmasia coerulea dolens.

Relative contraindications are weeping dermatoses, intolerances or allergies to the material used, peripheral polyneuropathies, chronic polyarthritis (rheumatoid arthritis).

Notice ! The possibilities of modern compression therapy allow today to treat almost all patients with the exception of the ABSOLUTE contraindications, taking into account the individual situation. If there are relative contraindications, an appropriate choice of material (e.g. flat-knit fabric, padding) and pressure reduction usually makes it possible to carry out compression therapy. However, the indication should always be determined individually and by a practitioner experienced in compression therapy.

Short-stretch bandages: Short-stretch bandages have a low elasticity of 40-90%. They are characterized by a working and low resting pressure. Short-stretch bandages are used with Pütter bandages or Sigg bandages. They should be checked regularly and adjusted if necessary.

Long-stretch band ages: Long-stretch bandages have a high elasticity of 150-200% and produce a high resting and low working pressure. Due to their elasticity, they can variably adapt to changes in the circumference and shape of the extremities. They can remain in place for several days.

Non-elastic bandages: They usually consist of zinc paste bandages, which have been used for over 1 century. Because of their "inelasticity", they have a high working pressure and a low resting pressure. They usually remain for several days.

Multi-component systems: Multi-component systems are used by various manufacturers. Companies offer multi-component systems as prefabricated systems. They consist of 2-4 components, such as padding, compression and fixation bandages. Some systems are provided with optical markings which are helpful for achieving an optimal contact pressure.

Ulcer stocking systems: ulcer compression stockings (see below /en/vascular-medicine/ulcer-compression-stocking-136375" title="Ulcer compression stocking) are indicated for patients with venous leg ulcers following the decongestion phase. They are adjusted after measurement of the lower legs.

Medical compression stockings: they are manufactured according to the RAL standard and offer a contact pressure that decreases from distal to proximal. They are divided into 4 classes according to their resting contact pressure in the ankle area. They can be made to measure or as a series, in round or flat knitting. See also /en/vascular-medicine/compression-stocking-medical-135697" title="Compression stocking medical.

Wrap bandages: With these compression bandages the pressure can be adjusted segmentally over several velcro systems. A readjustment is possible at any time. /en/vascular-medicine/wrap-bandages-136376" title="Wrap bandages

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2. Dissemond J (2016) Compression therapy as individualized therapy for leg ulcers. Vasomed 28: 24-26
3. Hechmat-Dehkordi A et al (2010) New, successful therapy for venous leg ulcers with the segmental-adaptive compression cuff (SAKM). Act Dermatol 36: 474-479
4. Hohlbaum GG (1987) The history of compression therapy (I). Phlebology and proctology 16: 241-255
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7. Wienert V et al (1996) Guidelines on phlebological compression bandaging (PKV). Phlebology 65: 207-208