A Randomised Trial of Different Compression Dressings Following Varicose Vein Surgery

Compression stockings for the initial treatment of varicose veins in patients without venous ulceration

BACKGROUND

Compression hosiery or stockings are often the first line of treatment for varicose veins in people without either healed or active venous ulceration. Evidence is required to determine whether the use of compression stockings can effectively manage and treat varicose veins in the early stages.

OBJECTIVES

To assess the effectiveness of compression stockings for the initial treatment of varicose veins in patients without healed or active venous ulceration.

SEARCH METHODS

The Cochrane Peripheral Vascular Disease Group searched their Specialised Register (last searched 31 May 2011) and CENTRAL (2011, Issue 2). In addition, the reference lists of relevant articles were searched. Authors of ongoing and current trials were contacted. There were no language restrictions.

SELECTION CRITERIA

Randomised controlled trials (RCTs) were included if they involved participants diagnosed with primary trunk varicose veins without healed or active venous ulceration (Clinical, Etiology, Anatomy, Pathophysiology (CEAP) classification C2 to C4). Included trials assessed compression stockings versus no treatment, compression versus placebo stockings, or compression stockings + drug intervention versus drug intervention alone. Trials comparing different lengths and pressures of stockings were also included. Trials involving other types of treatment for varicose veins (either as a comparator to stockings or as an initial non-randomised treatment), including sclerotherapy and surgery, were excluded.

DATA COLLECTION AND ANALYSIS

Two authors assessed the trials for inclusion and quality (SS and LR). SS extracted the data, which were checked by LR. Attempts were made to contact trial authors where missing or unclear data were present.

MAIN RESULTS

Seven studies involving 356 participants with varicose veins without healed or active venous ulceration were included. Different levels of pressure were exerted by the stockings in the studies, ranging from 10 to 50 mmHg. One study assessed compression hosiery versus no compression hosiery. The other six compared different types or pressures of stockings. The methodological quality of all included trials was unclear, mainly because of inadequate reporting.The symptoms subjectively improved with the wearing of stockings across trials that assessed this outcome, but these assessments were not made by comparing one randomised arm of a trial with a control arm and are therefore subject to bias.Meta-analyses were not undertaken due to inadequate reporting and actual or suspected high levels of heterogeneity.

AUTHORS' CONCLUSIONS

There is insufficient, high quality evidence to determine whether or not compression stockings are effective as the sole and initial treatment of varicose veins in people without healed or active venous ulceration, or whether any type of stocking is superior to any other type. Future research should consist of a large RCT of participants with trunk varices either wearing or not wearing compression stockings to assess the efficacy of this intervention. If compression stockings are found to be beneficial, further studies assessing which length and pressure is the most efficacious could then take place.

Multicenter randomized trial comparing compression with elastic stocking versus bandage after surgery for varicose veins

OBJECTIVES

Postoperative limb compression is widely used after venous surgery to prevent thromboembolism and to reduce hemorrhage, edema, hematoma, and pain. Only limited studies have been published regarding the most adequate postoperative compression therapy after varicose vein surgery. This study evaluated the effectiveness of a new stocking kit used for postoperative limb compression.

METHODS

The study compared the clinical practicability, ease to use, effectiveness, and safety of a postoperative stocking system (23 to 32 mmHg at the ankle) with compression bandages (control group). This prospective, randomized, open-label clinical trial, was performed in three Italian centers specializing in venous surgery. Sixty consecutive patients (classification CEAP C₂,(S)) underwent unilateral varicose vein surgery at one of the three centers. After surgery, patients were randomized for postoperative compression therapy with a new stocking system (Sigvaris Postoperative Kit; Ganzoni Sigvaris Corp, Winterthur, Switzerland) or standard stretch bandages (30 patients per group). Primary end points were incidence of venous thromboembolism, hemorrhage, limb hematoma, or edema.

RESULTS

No episodes of venous thromboembolism were observed. The mean area of thigh hematoma on postoperative days 7 and 14 was 75.70 cm² and 2.93 cm², respectively, for the stocking group, and 92.97 cm² and 5.42 cm² for the bandage group (not significant). On postoperative day 7, edema was found in 50% of the patients wearing bandages and in 20% of the patients wearing the stocking kit, which was a significant reduction. No statistical difference was recorded for postoperative pain; however, better patient acceptance and quality of life after the operation were recorded in the stocking group.

CONCLUSION

Patients can be effectively treated with the Sigvaris Postoperative Kit. Patients treated with stockings have less edema compared with standard bandaging, and the application of the stocking kit improves patient quality of life and compliance with postoperative compression therapy.

Résultats d’une enquête sur les techniques compressives et contensives utilisées dans le traitement chirurgical des varices

OBJECTIVES

A survey on postoperative compression after varicose vein surgery was undertaken in 2001 among surgeons of the French-speaking Vascular Surgery Society as well as non-members with a heavy caseload in varicose vein surgery. The aims of the study were to 1) identify the various medical devices and protocols used postoperatively, 2) estimate the frequency and duration of use, and 3) identify the surgeon's rationale for prescribing postoperative compression. The first part of the inquiry was devoted to surgical procedures and has been previously published (J Mal Vasc 2003; 28: 277-86).

MATERIAL AND METHODS

A questionnaire with 11 items for postoperative treatments and a patient form was mailed to 675 surgeons.

RESULTS

The response rate was 41.5% (280 surgeons). Results were assessed by a scientific committee. Surgeons were classified into different groups according to their membership in the French-speaking Vascular Surgery Society or not, the type of practice (private, public hospital, mixed), and caseload. Compression was widely used (97.1%). It was the only postoperative treatment for 25.2% of the surgeons, was associated with anticoagulant treatment for 38.8% or non-steroidal antiinflammatory drugs for 11.2%. Prescription was evidence-based for only 11.6%. Compression therapy was mainly started postoperatively (93.2%). Elastic bandages (long stretch) were used by 87%. Duration of bandage therapy was variable (less than 8 days for 38.8%, 8-15 days for 24.5%). After bandage therapy, medical compression stockings (above knee 74.7%) or French class II (77.9%) were used. Compression stockings were prescribed for 8-15 days or 15-30 days by 12.7% and 84.6% of the surgeons respectively. Prolonged postoperative treatment was not common (28%) and was prescribed for patients with trophic changes.