Haemodynamic Performance of Low Strength Below Knee Graduated Elastic Compression Stockings in Health, Venous Disease, and Lymphoedema

Eur J Vasc Endovasc Surg. 2016 Jul;52(1):105-12. doi: 10.1016/j.ejvs.2016.04.001. Epub 2016 May 6.


Objective: To test the in vivo haemodynamic performance of graduated elastic compression (GEC) stockings using air-plethysmography (APG) in healthy volunteers (controls) and patients with varicose veins (VVs), post-thrombotic syndrome (PTS), or lymphoedema. Responsiveness data were used to determine which group benefited the most from GEC.

Methods: There were 12 patients per group compared using no compression, knee-length Class 1 (18-21 mmHg) compression, and Class 2 (23-32 mmHg) compression. Stocking/leg interface pressures (mmHg) were measured supine in two places using an air-sensor transducer. Stocking performance parameters, investigated before and after GEC, included the standard APG tests (working venous volume [wVV], venous filling index [VFI], venous drainage index [VDI], ejection fraction [EF]) and the occlusion plethysmography tests (incremental pressure causing the maximal increase in calf volume [IPMIV], outflow fraction [OF]). Results were expressed as median and interquartile range.

Results: Significant graduated compression was achieved in all four groups with higher interface pressures at the ankle. Only the VVs patients had a significant reduction in their wVV (without: 133 [109-146] vs. class1: 93 [74-113] mL) and the VFI (without: 4.6 [3-7.1] vs. class1: 3.1 [1.9-5] mL/s), both at p <.05. The IPMIV improved significantly in all groups except in the PTS group (p <.05). The OF improved only in the controls (without: 43 [38-51] vs. class1: 50 [48-53] %) and the VVs patients (without: 47 [39-58] vs. class1: 56 [50-64] %), both at p <.05. There were no significant differences in the VDI or the EF with GEC. Compression dose-response relationships were not observed.

Conclusion: Patients with varicose veins improved the most, whereas those with PTS improved the least. Performance seemed to depend more on disease pathophysiology than compression strength. However, the lack of responsiveness to compression strength may be related to the low external pressures used. Stocking performance tests may have value in selecting those patients who benefit most from compression.

Keywords: Air-plethysmography; Graduated elastic compression stockings; Lymphoedema; Post-thrombotic syndrome; Stocking interface pressures; Varicose veins.

Publication types

  • Clinical Trial

MeSH terms

  • Adult
  • Aged
  • Case-Control Studies
  • Female
  • Hemodynamics / physiology*
  • Humans
  • Lymphedema / physiopathology
  • Lymphedema / therapy*
  • Male
  • Middle Aged
  • Plethysmography
  • Postthrombotic Syndrome / physiopathology
  • Postthrombotic Syndrome / therapy*
  • Prospective Studies
  • Stockings, Compression*
  • Treatment Outcome
  • Varicose Veins / physiopathology
  • Varicose Veins / therapy*