Why Compression

An abnormal accumulation of fluid trapped beneath the skin very commonly found in the feet and legs

Causes: Medications; liver or kidney disease; heart failure; venous insufficiencies; pregnancy/hormones, paralysis, surgery, lymphatic problems

Treatment: Treat the underlying cause, compression hosiery (or arm sleeves), lifestyle modifications, medications, properly fit shoes, and leg elevation.

Chronic venous disease occurs when the veins in your legs are not working effectively and it becomes increasingly difficult for blood to pass through the vein walls or valves to flow back to your heart. There are six stages of the disease, from spider veins in the earliest stage to open sores in the most advanced stage. 

In its mildest stage, CVD appears as spider veins, which may look like small red or blue tree branches or spider webs close to the skin surface. Spider veins may then develop into varicose veins, which are enlarged, rope-like blood vessels that are swollen and raised above the surface of the skin. In CVD’s more advanced stages, symptoms such as leg swelling with varicose veins may be present. You may also begin to see skin changes in your legs (usually a darkening of the skin or a rash due to pooling of blood and increased pressure in the veins). Or you may see a sore with a scab, usually on one or both of your inner ankles. In CVD’s most advanced stage, an open ulcer (sore) with oozing fluid may be present. Chronic venous insufficiency (CVI) is another name for the more advanced stages of CVD. 

While the progression of chronic venous disease does not appear to be affected by one’s gender, or favor one leg over the other, there are several risk factors:

• Age (over 50)
• Family history of varicose veins
• History of deep vein thrombosis (DVT)
• Obesity
• Smoking
• Pregnancy
• Prolonged periods of standing or sitting
• Damaged or diseased valves

Long standing condition where venous pressure fails to decrease with walking.  The valves in the deep venous system are damaged or destroyed and veins cannot pump enough blood back to the heart. Progresses if not treated with symptoms including shiny brown weepy skin, itchy, dull discomfort, pain when standing, recurrent ulceration is common.

Causes: Family history, pregnancy, diet, trauma/surgery, fracture, obesity, inactivity, age

Treatment: Anticoagulants, bed rest (acute cases), elevate leg, exercise, gradient compression during ambulation

Varicose veins affect both men and women.

Causes: Back up of blood in the veins caused by hereditary, pregnancy, occupation, or age.

Symptoms:  Bulging veins, aching and discomfort in thigh, leg heaviness and fatigue, inflammation

Treatment:  Compression hosiery helps relieve symptoms and slow progress; sclerotherapy, laser surgery, endovenous thermal ablation, microphelbectomy, endoscopic perforator vein surgery and other procedures are used.

• 30% of women experience varicose veins in their first pregnancy.
• 55% of women experience varicose or spider veins in their second or subsequent pregnancy.

Factors:  Hormones, pressure of the fetal head, and 40-50% increases in blood volume.

Treatment:  Compression Stockings are beneficial and recommended during pregnancy and post-partum.

DVT is a blood clot in a deep vein.  It is estimated that over 2 million people develop DVT in the US every year with a recurrence rate of approximately 30%. Recurrence rate can be cut in half through compression therapy.  Half of DVT patients had no prior symptoms.

If a DVT, or part of one, breaks away and gets into the bloodstream, it can block blood flow to the lungs. This is called a pulmonary embolism. A large pulmonary embolism can be deadly. Pulmonary embolism, along with DVT, kill as many as 180,000 Americans each year, more than the number of people who die from breast, prostate, colon, and skin cancers combined. Estimated that 1 in 100 patients that suffer a DVT will die.

Causes:  Inactivity, recent surgery, pregnancy, oral birth control pills, hormone replacement therapy, inherited blood clotting disorder, age, prolonged immobility, obesity, long surgical procedures, history of venous disease, and being big & tall.

Treatment:  Compression hosiery (both for prevention and treatment) and blood thinners

American College of Clinical Pharmacy (ACCP) guidelines call for compression therapy for a minimum of two years after DVT  

Inflammatory skin disease usually occurring in the lower extremities, often a precursor to venous ulcers. Presents as darkening of the skin at ankles/legs, itching and flaking, skin appears thin tissue-like or can be hard and scar-like. Estimates that it affects 1 million people per year in the US

Causes: Fluid accumulation in tissues beneath skin, capillaries unable to remove waste, tissue becomes malnourished and fragile.  Other causes include elderly, diabetes, obesity, peripheral vascular disease, smoking, sedentary life-style, varicose veins, or chronic venous insufficiency.

Treatment: Compression, topical steroids, antibiotics, lifestyle modifications, vein surgery

Form at the end stage of venous insufficiency; an open wound usually found on inside of ankle, usually with irregular borders, may have partial skin loss, may have yellow or greenish discharge, painful to stand. An estimated 1 – 2 million people in the US suffer from leg ulcers and 30% will experience recurrence without treatment. 

Causes: Chronic venous insufficiency, varicose veins, sedentary or non-ambulatory, edema, history of DVT, or a family history of leg ulcers.

Treatment:  Compression, Lifestyle modifications, nutrition evaluation, Antibiotics, topical wound care, surgery