Graduated Compression Stockings for the Initial Treatment of Varicose Veins in People Without Venous Ulcers
Knight (nee Shingler) SL, Robertson L, Stewart M. Graduated compression stockings for the initial treatment of varicose veins in persons without venous ulcers. Cochrane Database of Systematic Reviews 2021, No. 7. Art. No.: CD008819. doi: 10.1002 /14651858.CD008819.pub4. Accessed July 29, 2021.
Commentary
This study was being conducted with the aim of assessing the effectiveness of compression stockings for the sole initial treatment of varicose veins in people without healing, or active venous ulcers.
The main results of the study were reviewed including 13 studies with 1021 participants with varicose veins without healing or active venous ulcers.
One study included pregnant women, and the others included participants who sought medical intervention for varicose veins by being on a surgical waiting list or attending a vascular surgery or dermatology clinic or outpatient clinic.
The stockings used in the studies applied varying levels of pressure ranging from 10 mmHg to 50 mmHg. five studies compared compression stockings with no placebo stockings. Three of these studies used knee-length stockings, one used full-length stockings, and the other used full tights.
Eight of the studies compared different types or pressures of knee-length stockings. The risk of bias in many of the included studies was unclear, mainly due to inadequate reporting.
Compression stockings compared to no treatment or placebo stockings
All four studies that reported changes in symptoms showed subjective improvements by the end of the study, but changes in symptoms were affected by bias.
Two studies assessed physiological measurements using either ankle circumference or duplex ultrasonography to measure edema, and although ankle circumference did not show a clear difference between baseline and follow-up, edema was reduced in the stocking group compared to the placebo stocking group.
All three studies reported complications or side effects involving itching or irritation, but none of the studies reported serious side effects.
Compression stockings compared to different compression stockings
All five studies that reported changes in symptoms showed subjective improvement in symptoms. However, the change in symptoms was subject to bias because the studies did not compare randomized groups.
Five studies reported a variety of physiological measures, including changes in foot volume, volume reduction, and diameter, but there were no clear differences between the study groups. four studies reported complications or side effects, including sweating, itching, dry skin, and contractures and strains, and no trials reported serious side effects. .
Due to the lack of conclusive results from the included studies, it was not possible to draw any conclusions regarding the optimal length or pressure of compression stockings.
The authors conclude that
There is insufficient evidence of a high degree of certainty to determine whether compression stockings are effective as the only initial treatment for varicose veins in persons without healing, or active venous ulcers, or whether any type of stocking is superior to any other type.
Future studies should consist of large RCTs of participants with body varicose veins, with or without compression stockings, to assess the effectiveness of this intervention. If compression stockings are found to be beneficial, further studies could be conducted to evaluate which lengths and pressures are most effective.
