Stockings and Compression

Devices for Venous and

Lymphatic Disease

Thom Rooke

Krehbiel Professor of Vascular Medicine

Mayo Clinic

Disclosure

Thom Rooke, M.D., FACC

I have no financial relationship(s) to disclose.Osborn Medical – Royalty

Merck – Event Adjudication

Advanced Venous Therapy – Royalty

Why treat venous / lymph disease?

• Pain

• Edema

• Cosmesis

• Prevention

• Pain

• Edema

• Cosmesis

• Prevention

• mattress tester

• skinny jean model

Job may be

affected:

Why treat venous / lymph disease?

So what?

• Pain

• Edema

• Cosmesis

• Prevention

Why treat venous / lymph disease?

• Pain

• Edema

• Cosmesis

• Prevention

Problem: Cosmesis has a big

subjective component

Payors routinely cover for:

Burns / Mastectomy / Birth

Defects / Others

Why treat venous / lymph disease?

Carrot Top

Carrot Top

• Pain

• Edema

• Cosmesis

• Prevention

… Surprisingly, compression has

never been shown to prevent ulcer

formation in patients with primary

venous insufficiency. Post deep vein

thrombosis, compression has been

shown to prevent post-thrombotic

syndrome and ulcer formation …

Chronic Venous Insufficiency

By Dr. Ido Weinberg | Published: March 16, 2011

Why treat venous / lymph disease?

How to treat venous / lymph disease

Fix the

problem

Really Good !

Fix the

problem

How to treat venous / lymph disease

Not so Good !

Manage the

problem

How to treat venous / lymph disease

Elastic

Manage the

problem

How to treat venous / lymph disease

Non-Elastic

How

compression

works …

Instead, an

editorial

comment …

Stockings

Improve Don’t Improve

Continue Surgery

Vein Disease

Effectiveness

Availability

Cost

Acceptability

versus

Conventional WisdomCompression versus

InterventionFor treatment of Venous Disease

Effectiveness

Availability

Cost

Acceptability

J Vasc Surg. 1987 Jan;5(1):148-59.

Air-plethysmography and the effect of elastic

compression on venous hemodynamics of the leg.Christopoulos DG, Nicolaides AN, Szendro G, Irvine AT, Bull ML, Eastcott HH.

AbstractLeg volume changes during exercise have been measured in absolute units

(milliliters) by means of a new method of air-plethysmography … …

measurements were repeated with a graduated medium compression stocking

in limbs with SVI and graduated high compression stockings in limbs with

DVD. … The results indicate that this method of air-plethysmography is not

only of diagnostic value but offers a new and unique technique to assess and

study the hemodynamic effects of different forms of elastic compression.

The lower ambulatory venous pressure,

produced by the elastic compression, was the

result of a reduction in reflux and an

improvement in the calf muscle ejecting ability

during rhythmic exercise.

Factors affecting choice of therapy for

venous / lymphatic disease

Surgery = Effective

http://www.ncbi.nlm.nih.gov/pubmed?term=%22Christopoulos%20DG%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Nicolaides%20AN%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Szendro%20G%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Irvine%20AT%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Bull%20ML%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Eastcott%20HH%22%5BAuthor%5D

Effectiveness

Availability

Cost

Acceptability

…Stony Brook

Vein Center…

Factors affecting choice of therapy for

venous / lymphatic disease

Effectiveness

Availability

Cost

Acceptability

Factors affecting choice of therapy for

venous / lymphatic disease

Effectiveness

Availability

Cost

Acceptability

“Conservative”

isn’t cheap.

Just “cheaper.”

Factors affecting choice of therapy for

venous / lymphatic disease

Surgical

Therapies

Stockings

Effectiveness

Availability

Cost

Acceptability

• Hard to get on

– DJD, age

• Hot / Tight /

Uncomfortable

• Don’t “cure”

the problem Ugly

Factors affecting choice of therapy for

venous / lymphatic disease

Surgery – not so

invasive anymore

Trends in Patient Reported Outcomes of Conservative and Surgical Treatment of Primary Chronic Venous

Disease Contradict Current Practices

Lurie, Kistner

American Venous Forum -- San Diego, 2011

150 patients / C 2-4 / SQOR – V / Symptom Score and QOL

150

74% 26%

% Improved with stockings

80% opted to discontinue

stockings and have surgery

Chances of improving

with surgery are 21X

higher if there is

improvement with

stockings !!% Did Not Improve …

Conventional Wisdom

Stockings

Improve Don’t Improve

Continue Surgery

More Logical

Improve

Surgery

Don’t Improve

Compression

Even Better?

Surgery

Vein Disease Vein Disease

Vein Disease

ImproveDon’t

ImproveCompression

The End