Compression treatment in venous insufficiency and arterial disease

Summary

Compression therapy is one of cornerstone in the treatment of venous and lymphatic disorders.

It may be applied by means of different elastic or inelastic stockings, bandages, or other devices. Inelastic material is much more effective improving venous impaired haemodynamics than elastic material. Due to its physical properties inelastic material is able to exert a significantly higher pressure than elastic devices moving to the standing from the supine pressure; furthermore it is able to exert significantly higher pressure peaks during muscle exercise. This high pressure can overcome the intravenous pressure and cause intermittent occlusion of leg veins, restoring a kind of valve mechanism. Elastic material gives way to the muscle expansion during standing and walking and the pressure increase in these conditions is very low. Due to this low increase with muscle activity, elastic material does not exert an intermittent pressure but rather a sustained pressure not able to overcome the intravenous pressure. As a consequence, elastic material is hardly able to influence the venous diameter and its haemodynamic effects are minimal.

Compared to elastic, inelastic material is significantly more effective in reducing venous reflux, increasing venous pumping function and reducing ambulatory venous hypertension.

Compression therapy proved to be beneficial, over time, in every clinical condition from CEAP C1 to C6.

Due to their characteristics and effects, in-elastic compression needs to be applied in the acute stages of venous disorders when a strong haemodynamic effect is necessary, while elastic stockings may be used in the chronic stages to maintain the results and prevent recurrences.

A new concept in compression therapy is the inversely graduated compression pressure profile, higher over the calf than over the ankle, also named “progressive compression.” Both specially designed elastic stockings and appropriately applied bandages can exert a progressive compression which showed some interesting outcomes both in experimental and clinical settings in patients with chronic venous disorders and in athletes. Nevertheless its effectiveness in many pathological conditions (oedema treatment, venous leg ulcer, thromboprophylaxis, etc.) needs to be proved in future trials.

Zusammenfassung

Die Kompressionstherapie ist einer der Eckpfeiler bei der Behandlung von venösen und lymphatischen Erkrankungen.

Sie wird mittels verschiedener elastischer oder unelastischer Produkte durchgeführt. Unelastisches Material wirkt sehr viel stärker auf die beeinträchtigte venöse Hämodynamik als elastisches Material. Beim Aufstehen aus lie-gender Position kann unelastisches Material aufgrund seiner physikalischen Eigenschaften einen deutlich höheren Druck ausüben als elastische Kompressionsbekleidung; außerdem können damit während der Muskelbewegung bedeutend höhere Spitzendrücke erreicht werden. Dieser hohe Druck beim Stehen und Gehen kann den intravenösen Druck übersteigen und einen intermittierenden Verschluss der Beinvenen bewirken, sodass wieder eine Art Klappenmechanismus hergestellt wird. Hingegen übt elastisches Material keinen derartigen intermittierenden Druck, sondern eher einen anhaltenden Druck aus. Elastisches Material gibt den Muskeln beim Stehen und Gehen Raum zur Ausdehnung, wobei der Druckanstieg unter diesen Bedingungen sehr gering ist. Der ausgeübte Druck kann den intravenösen Druck nicht übersteigen und somit auch den Venendurchmesser nicht beeinflussen, sodass die hämodynamischen Effekte minimal sind.

Im Vergleich zu elastischem Material ist das unelastische Material signifikant wirksamer bei der Reduktion des venösen Reflux, der Steigerung der venösen Pumpfunktion und der Reduktion der venösen Hypertonie beim Gehen.

Die Kompressionstherapie hat sich mit der Zeit in allen klinischen Stadien, von CEAP C1 bis C6, als wirksam erwiesen.

Aufgrund ihrer Eigenschaften und Wirkungen muss im akuten Stadium einer Venenerkrankung, wenn ein starker hämodynamischer Effekt notwendig ist, eine unelastische Kompression angelegt werden; dagegen können in chronischen Stadien elastische Strümpfe verwendet werden, um das Erreichte zu erhalten und Rezidiven vorzubeugen.

Ein neues Konzept bei der Kompressionstherapie ist das invers abgestufte Kompressionsdruckprofil, bei dem der Druck über der Wade höher ist als über dem Sprunggelenk und das auch als „progressive Kompression“ bezeichnet wird. Die progressive Kompression kann mit speziell entwickelten elastischen Strümpfen oder mit entsprechend angelegten Kompressionsbinden erzielt werden und hat bei Patienten mit chronischen Venenerkrankungen sowohl unter experimentellen als auch klinischen Bedingungen sowie bei Sportlern bereits interessante Ergebnisse gezeigt. Seine Wirksamkeit muss jedoch bei vielen pathologischen Zuständen (Ödembehandlung, venöses Beinulkus, Thromboseprophylaxe, usw.) in zukünftigen klinischen Studien noch nachgewiesen werden.

Keywords

Compression therapy - chronic venous insufficiency - arterial disease - elastic bandage - elastic stockings - inelastic bandage - velcro devices

Schlüsselwörter

Kompressionstherapie - chronische Veneninsuffizienz - arterielle Erkrankungen - elastische Bandagen - elastische Strümpfe - nicht-elastische Bandagen

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