Compression therapy in veno-lymphatic disorders
Different types of compression products in veno-lymphatic disorders: Characteristics of compression therapy types and on how to choose the best garment.
Background
Prevalence of veno-lymphatic disorders
Venous disorders (1)
- C1 (spider and reticular veins): 59.1%
- C2 (varicose veins): 14.3%
- C3 (chronic leg edema): 13.4%
- C4-C6 (skin changes, healed/open ulcer): 3.6%
Lymphatic disorders (2):
- Lymphedema: 1.8% (2% women; 1.5% men)
- Primary lymphedema: 1/3 of all lymphedema patients
- Secondary lymphedema: 2/3 of all lymphedema patients
Lipedema (3):
- Predominantly in women: 6–8%
Management
The management of venolymphatic disorders is multifactorial and includes:
- Compression therapy, a well-established treatment for veno-lymphatic conditions (4)
- Skin care
- Surgical techniques & other therapies
- Exercise / weight management
- Lymphatic drainage
This One-Pager focuses on compression therapy mechanisms, benefits and types, and on how to choose the best garment for an individual patient.
Compression therapy
Mechanisms of action (5):
- Improves venous return
- Decreases filtration
- Enhances lymph formation & lymphatic flow
- Reduces inflammation (6)
Beneficial effects (5):
- Reduces signs & symptoms
- Reduces & prevents edema
- Accelerates wound healing
- Improves & prevents skin conditions
- Reduces mechanical impairment & pain
- Increases physical activity & tissue stabilization; enhances quality of life
Compression therapy types
Circular knit
Characteristics (4)
- Fine, discrete stockings; softer, more elastic & esthetic than flat knit; no seam
- Long-stretch properties; lower working pressure than flat knit
- Availability of made-to-measure garments
- Lower costs than flat knit or compression wraps
- CVI (C0-C6; examples: heavy legs, varicose veins, early/mild edema; venous leg ulcers with the ULCER X kit)
- Mild to moderate lymphedema, lipedema or lipolymphedema, if limb has a uniform shape; can be used for the decongestive, transition or maintenance phase
Flat knit
Characteristics (4)
- Thicker & stiffer materials compared to circular knit; highly resistant; with seam
- Short-stretch properties; higher working pressure than circular knit
- Flexible & versatile (custom-made)
- Comfortable with soft tissue or skin folds; comfortable at high compression classes
- Moderate CVI (C3-C4)
- Mild to severe lymphedema, lipedema, lipolymphedema, with or without shape distortion (tissue containment); maintenance phase (can be used for the decongestive & transition phase); recommended after bandaging to prevent rebound
Compression wraps
Characteristics (4)
- Allow self-management (self-application & -adjustment, self-hygiene & skin care); enhanced treatment
effi cacy & enhanced quality of life; cost-effective (washable, re-usable; time-saving); comfortable thanks to self-adjustment - Short-stretch properties; high working pressure & low resting pressure
- Moderate/severe CVI (C3-C6)
- Mild/moderate to severe lymphedema, lipedema or lipolymphedema, with or without shape distortion; maintenance phase (can be used for the decongestive & transition phase); also used to prevent rebound
Compression classes & pressure characteristics
Compression classes (pressure at ankle)
Compression therapy exerts a controlled pressure on a limb. Different compression classes exist (depending on the regional norms) for circular knit and flat knit products.
Pressure characteristics
- Resting pressure: pressure created at the interface of the compression textile and the limb in a supine position (when resting). This corresponds to the compression class of a given product.
- Working pressure: pressure created at the interface of the compression textile and the limb during movement. The increase in pressure that occurs during movement depends on the fabric stiffness. Stiffer material results in a greater increase in working pressure.
Two garments of the same compression class produce the same resting pressure, but the stiffer garment produces a higher working pressure.
A high stiffness effectively reduces edema, but it makes the donning of compression stockings difficult: this is why compression stockings have a lower stiffness compared to bandages or wraps.
Choosing the right garment
The choice of the correct garment for an individual patient is influenced by many factors (4), (7):
- Clinical status of the patient (condition for which the garment is to be used; stage, severity & swelling site of edema)
- Age, mobility, ability to manage/tolerate garments
- Skin condition (fragile, ulcerated, normal)
- Limb morphology
- Stiffness of the fabric
- Self-care (health status, patient’s understanding of condition & desire to change) & financial situation of patient
- Patient's preference
Take-home message
Compression therapy is a cornerstone in the management of veno-lymphatic disorders. A wide variety of compression products exist, each having specific characteristics that make them more or less suitable for an individual patient. The selection of the correct compression garment should consider many different factors. This is crucial for an effective and patient-centered therapy.
Note: All patients must have had a holistic assessment including ABPI before prescribing garments / medical devices.
Further reading
Adjustable compression wraps: applications & benefits
This One-Pager reviews the scope of application as well as the benefits of adjustable compression wraps. It is available for download in English, German, French, Italian, Polish and Spanish. Adjustable compression wraps can be used for the management of lymphedema, chronic venous insufficiency and lipedema. The combination of material attributes (high working pressure, low resting pressure) and design properties (self-adjustability) offers many benefits over conventional bandages. Wraps can be self-applied by the patient or caregiver, and are therefore ideal for patients with limited access to care centers. They can be self-adjusted in the case of loosening or discomfort. The treatment efficacy in upper and lower limbs is enhanced. A further benefit of adjustable compression wraps is the cost-effectiveness through material saving and through time saving. Overall, wearing compression wraps results in an enhanced quality of life.
Venous edema
If the volume of your legs is constantly increased, and pressure on the affected part leaves an indent, you have edema. The cause could be venous or lymphatic. A doctor’s consultation will provide the correct diagnosis. Compression therapy is the basic therapy for edema.
The Sigvaris ULCER X kit is highly effective in the treatment of venous leg ulcers.
This One-Pager reviews the effects of the SIGVARIS ULCER X kit in the treatment of venous leg ulcers. Wearing the ULCER X kit is more effective in healing venous leg ulcers than conventional bandaging with faster healing of small ulcers <4 cm. This study demonstrates that the SIGVARIS ULCER X kit can be effectively used for the treatment of venous leg ulcers. In addition, quality of life increases when wearing the ULCER X kit compared to bandages. This Medical One-Pager is published in English, German, French, Italian and Polish.
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