Post-treatment compression: duration and techniques

Comparative Efficacy of Postoperative Compression Methods After EVLT for Great Saphenous Vein Insufficiency

Introduction: The preference for endovascular techniques in treating varicose veins, particularly in the great saphenous vein (GSV), has increased due to their minimally invasive nature and reduced complications. Post-operative care, especially involving compression therapy, remains crucial to improve outcomes, prevent varicose vein recurrence, and enhance overall recovery. This study aimed to evaluate the efficacy of eccentric compression therapy compared to alternative post-operative care methods following endovenous laser treatment (EVLT) for GSV insufficiency. Methods: This prospective randomized clinical trial encompassed 88 EVLT procedures for GSV insufficiency. The participants were divided into two groups, each receiving different postoperative compression methods, and were evaluated over a specified period. The primary outcome was the pain scale after EVLT; meanwhile, the secondary outcome measured in the present study was the rate of GSV occlusion after EVLT. Results: Both groups underwent all EVLT procedures successfully without any complications. At the one-month duplex ultrasound (DUS) follow-up, the sapheno-femoral junction occlusion rates were 97% (43 out of 44) for group A (eccentric compression plus gradual compression stocking) and 95% (42 out of 44) for group B (only gradual compression stocking). Ecchymosis was observed in only 12 patients across both groups, accounting for an overall occurrence of 13.6%. Group A patients reported significantly lower analgesic usage (10%) compared to group B (18%), although this difference did not reach statistical significance. Analysis of postoperative pain data utilizing the visual analog scale (VAS) showed a median value of 5.5 in group B patients, which decreased to 3.1 with the application of eccentric compression. Moreover, there was less ecchymosis in group A observed by one week. Conclusion: This study contributes to the ongoing discourse on the efficacy of postoperative compression in varicose vein treatment. It underscores the necessity for more comprehensive, well-designed studies to yield clearer conclusions and provide better guidance for post-procedure care.

Compression versus no compression after endovenous radiofrequency ablation: A meta-analysis of randomized controlled trials

OBJECTIVES

The aim of this meta-analysis was to compare compression with no-compression, after radiofrequency endothermal ablation of a truncal varicose vein.

METHODS

Databases, such as PubMed, Embase, Cochran Library, and Web of Science, were independently searched by two researchers for relevant literature, preliminary screening was performed, and the full text was read to select studies that met the inclusion criteria. The quality of the included literature was evaluated using the Cochrane Risk of Bias tool, and meta-analysis was performed using Review Manager 5.4.

RESULTS

A total of four randomized controlled trials were included and a total of 552 patients were involved. Among them, 273 patients were in the compression group and 279 in the no-compression group. Meta-analysis results showed that the pain using the 100 mm Visual Analogue Scale was lower in the compression group than the pain in the no-compression group (MD = -4.22, 95% CI = -7.95 - -0.49, p = 0.03). No significant differences in terms of occlusion rate (RR = 0.99, 95% CI = 0.96-1.02, p = 0.55), Aberdeen Varicose Vein Questionnaire (MD = 0.46, 95% CI = -0.80-1.73, p = 0.47), and complications (OR = 1.33, 95% CI = 0.61-2.94, p = 0.47) were observed between groups.

CONCLUSIONS

This meta-analysis suggests that compression therapy reduced post-operative pain compared to the no-compression group. However, no additional advantages were observed in terms of occlusion rates, quality of life scores and complications.

Film compression bandage

Purpose: Textile compression stockings or bandages are limited in comfort; they do not allow uninterrupted wearing. A novel elastic film bandage was evaluated regarding practicability, patient comfort and effect on vein regression. Main endpoint was the frequency of symptomatic inflammatory reactions.

Methods: In a comparative pilot study, a compression film bandage (CFB, investigational) comprising an elastic, self-adhesive breathable polymer film of d <20 µm was continuously worn for 14 d after foam sclero-therapy. Inclusion: 62 patients (26–68 y.) frequently doing sports and taking daily showers, 90 legs with superficial varicosities, 5–12 mm ø (MW: 7.3 mm), randomized to A) CFB + medical compression stocking (MCS), B) MCS alone, C) CFB alone. Follow-up examinations including ultrasound and photography were performed after 2, 4 and 8 weeks.

Results: Continuous wearing time of 14 days was completed in 57/60 cases with CFB (95.0 %, A+C), while 3/60 (5.0 %) finished wearing after 8–10 d. There were no adverse skin reactions except minor irritations at the upper edge (n = 2). Vein diameters were reduced within 14 days by 29–54 % (mean: 43.5 %) in group A, 16–44% (mean: 39.1 %) in group B, and 24–50 % (mean: 37.3 %) in group C. Symptomatic inflammation, indu-ration or discolouration was observed within 28 days in 5/60 cases (8.3 %) when using CFB (A, C) versus 19/30 (63.3%) related to stocking compression (B). Comfort was rated by the patients 6.6 (A), 4.3 (B) and 9.2 (C) on a 10 degree scale. This difference was statistically highly significant (p <0.01).

Conclusions: The film bandage is an effective and safe compression modality. For superficial varicosities the adhesive bond to the skin seems to be relevant additional to the elastic properties. The device significantly improves vein regression of foam-treated superficial varicosities when combined with compression stockings or even as stand-alone modality. Continuous wearing for two weeks is well tolerated. The bandage may also offer an alternative for patients not tolerating textile compression media, or during summer.

Eccentric compression of large varicose veins after foam sclerotherapy using a novel silicone gel pad

Ziel: Wir evaluierten eine neuartige exzentrische Kompression, die ultraschalltransparentes Silikon-Gel zwischen selbstklebenden Fo-lien als individuelles Druckpolster verwendet.

Methodik: Es wurden 120 Patienten mit 148 oberflächlichen Varizen (Ø 5,1–13,7 mm; MW: 7,6) nach Schaumverödung einbezogen: A) segmental randomisiert mit fokaler Kompression durch Silikon-Gel-Polster (Venartis® SGP) für 14 Tage plus Kompressionsstrumpf KKl. 2 (KS) tagsüber für 28 Tage, oder B) nur KS. Das SGP-System besteht aus einer selbstklebenden Basisfolie, auf die Silikon dem Venenverlauf folgend aufgetragen wird. Eine zweite Folie bedeckt Gel und Basisfolie. Den Patienten war Duschen erlaubt. Ermittelt wurden Querschnittsreduktion (QR, Ultra-schallscans) sowie klinische Parameter nach 2, 4 und 8 Wochen.

Ergebnisse: Segmente mit SGP zeigten gegenüber KS eine höhere QR, im Mittel 52,5 vs. 23,1 % (2 Wo), 48,4 vs. 28,9 % (4 Wo) und 66,7 vs. 39,2 % (8 Wo). Entzündungsreaktionen waren unter SGP mit 12,4 vs. 39,9 % signifikant seltener, ebenso Verfärbungen mit 10,8 vs. 35,1 %. Minithrombektomien (8,1 vs. 29,7 %) und orale Analgetika (6,8 vs. 19,6 %) wurden seltener benötigt. Unerwünschte Wirkungen: Diskrete Hautirritationen (10,1 %).

Schlussfolgerung: Indikationsspezifische Silikonhärten, Dosierungen, Tragezeiten und die Höhe externer Drücke bedürfen weiterer Untersuchungen, wobei die Ultraschalltransparenz neue Wege eröffnet.

Foam sclerotherapy of segments of the saphenous vein with adjuvant hyaluronan compression

Background: Thermal, mechano-chemical and chemical methods of vein closure are increasingly less effective in saphenous veins with diameters above 10 mm. Furthermore, increasing vein size is associated with unpleasant inflammatory reactions, in particular in locations close to sensitive structures like the skin. External compression media are not able to prevent these unwanted sequela in a tolerable way. As a possible solution, perivenous hyaluronan compression was evaluated combined with microfoam sclero-therapy.

Methods: 34 patients (25 f, 9 m, 43–71 yr/o) with saphenous insufficiency (GSV), dia -meters 10.1–23.1 mm (M: 14.1 mm), distance to skin: >10 mm, received a vein lumen compression oft thigh- or calf segments by perivenous injection of a NASHA gel mediated by a coaxial paravenous catheter prior to catheter-applied microfoam sclerotherapy (aethoxysklerol 1 %). Injection of both, hyaluronan and microfoam, were performed during catheter withdrawal. The aim of hyaluronan compression was a 2/3 reduction oft the native vein cross section. For comparison, adjacent segments were compressed with common tumescent fluid. Segments for both modalities had similar diameter and were randomized. Due to department rules, the junction segment was closed with endovenous lasers to warrant elimination of reflux. No textile compression media were applied. Clinical controls including ultrasound were performed after 2, 8, 26 and 54 weeks.

Results: All treated vein segments showed total occlusion after 2 weeks (first visit). The lumen reduction was 54–81 % (M: 68.4 %) in segments with hyaluronan compression and 8–29 % (M: 19.2 %) in segments with tumes-cent fluid. Time needed for hyaluronan compression was 1.1–3.5 min (M: 2.2 min) and for tumescence 0.8–2.7 min (M: 1.8 min) per 10 cm-segment. Clinical investigations up to 8 weeks did not reveal any symptoms, visible inflammations or stainings in segments covered with hyaluronan, while tumescent-compressed segments had such findings in 20/34 cases (58.8 %). Perivenous hyaluronan did not induce any discomfort or side effects during follow-up.

Conclusions: Even large saphenous veins can be effectively and safely treated by microfoam sclerotherapy without any postinterventional symptoms when the vein lumen is reduced by perivenous injection of hyaluronan gel. However, it takes additional interventional effort to achieve this goal. Future applications could also include combinations with thermal or gluing device or support novel foams like Varithena or biomatrix sclerofoam when treating very large veins or venous aneurysms, and furthermore serve in vein shaping fort the purpose of establishing laminar flow or modifying pressure relations (venoplasty).

A systematic review of the compression regimes used in randomised clinical trials following endovenous ablation

Objectives

There is insufficient evidence to inform guidelines on the optimal compression strategy following ablation for varicose veins. This study aimed to identify the practice of key opinion leaders performing randomised clinical trials involving endovenous ablation.

Method

A systematic review of MEDLINE/EMBASE/CENTRAL was performed identifying the compression strategies used in randomised clinical trials where at least one comparator arm underwent endovenous ablation.

Results

Thirty-four randomised clinical trials were identified. At least 14 different compression products were used, with at least 6 different pressures in 7 different regimes with durations from 2 to 84 days. There was no evidence of any convergence of practice over time.

Conclusions

A lack of evidence as to the optimal strategy for compression has resulted in a marked variation in clinical practice. There is no suggestion that this variation is becoming less over time indicating that experience is not helping to form a consensus and, therefore, further research is required.

Compression stockings after endovenous laser ablation of the great saphenous vein: a prospective randomized controlled trial

OBJECTIVES

To determine if the duration of wearing compression stockings after endovenous laser ablation (EVLA) of the great saphenous vein (GSV) has influence on pain and quality of life.

METHODS

This was a prospective randomized controlled trial. Between December 2006 and February 2008, 109 consecutive patients with EVLA of the GSV were analyzed. Deep vein insufficiency, ulceration, more than one insufficient vein in one leg, and use of anticoagulants were exclusion criteria. Group A used compression stocking for 48 hours after therapy, group B for 7 days. Pain (visual analogue scale [VAS]) and quality of life (SF-36) were analyzed 48 hours, 1 week, and 6 weeks after therapy. Three months after treatment, duplex ultrasound imaging was performed to assess occlusion rates.

RESULTS

Both groups (group A, n = 37; group B, n = 32) where comparable at baseline. After 1 week, there was a significant difference in pain (VAS score 3.7 [± 2.1] vs. 2.0 [± 1.1], p ≤ .001), and physical dysfunction (group A, 85.1 [± 11.2] vs. group B, 95.7 [± 10.1]; p < .001) as well as vitality (group A, 75 [± 13.0] vs. group B, 83.7 [± 13.4]; p = .03), all in favor of group B, which disappeared after 6 weeks. After 6 weeks, no significant differences in all endpoints were present. Duplex ultrasound imaging revealed complete GSV occlusion in all patients, while no cases of deep venous thrombosis had developed.

CONCLUSIONS

Prescribing compression stockings for longer than 2 days after endovenous GSV ablation (without simultaneous phlebectomies) leads to reduced pain and improved physical function during the first week after treatment.