Effects of Preventive Use of Compression Stockings for Elderly With Chronic Venous Insufficiency and Swollen Legs: A Systematic Review and Meta-Analysis

Abstract

Background: Many home-dwelling elderly use medical compression stockings to prevent venous insufficiency, deep venous thrombosis, painful legs and leg ulcers. Assisting users with applying and removing compression stockings demands resources from the home based health services, but the effects are uncertain. This systematic review aims to summarize the effects of preventive use of medical compression stockings for patients with chronic venous insufficiency and swollen legs. Methods: We conducted a search in six databases (Epistemonikos, Cochrane Database of Systematic Reviews, MEDLINE, Embase, CENTRAL and CINAHL) in March 2018. Randomized controlled trials evaluating the preventive effects of European standard compression stockings class 3 or 2 for elderly with chronic venous insufficiency and swollen legs were included. Primary outcomes were thrombosis, leg ulcers and mobility. Secondary outcomes were other health related outcomes, e.g. pain, compliance. We assessed risk of bias in the included studies and used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool for evaluating the overall quality of evidence. Results: Five randomized controlled trials met the inclusion criteria. Comparing compression stockings class 2 to class 1, meta-analysis showed a reduction in leg ulcer recurrence at 12 months (RR 0.52; 95% CI 0.30 to 0.88). The quality of evidence was assessed as moderate by GRADE. One study (100 participants) did not detect a difference between compression stockings class 3 versus class 2 on ulcer recurrence after six months (RR 0.64; 95% CI 0.20 to 2.03). In another study, patients wearing class 3 compression stockings had lower recurrence risk compared with patients without stockings (RR 0.46; 95% CI 0.27 to 0.76) at six months and (RR 0.43; 95% CI 0.27 to 0.69) at 12 months. We found no difference between class 2 and class 1 stockings on subjective symptoms of chronic venous insufficiency or outcomes of vein thrombosis or mobility. Conclusion: Compression stockings class 2 probably reduce the risk of leg ulcer recurrence compared to compression stockings class 1. It is uncertain whether the use of stockings with higher compression grades is associated with a further risk reduction. More randomized controlled trials on vein thrombosis and mobility are needed.

Prevalencia de enfermedad venosa crónica en personal de salud y su impacto en calidad de vida a 6 meses

“…La IVC cursa con un flujo sanguíneo deficiente en las venas profundas de la pierna, generalmente causada por válvulas venosas inadecuadas y se caracteriza por hipertensión venosa sostenida y por reflujo en la ecografía Doppler. El reflujo se define típicamente como un flujo sanguíneo retrógrado en las extremidades inferiores mayor de 0.5 s después de la provocación 2 , o > 0.5 s en venas superficiales y 1.0 s para venas profundas 3 ; así como acumulación de sangre en las venas profundas de las piernas. Además, la IVC puede favorecer úlceras crónicas de pierna y trombosis venosa profunda 2 .…”

“…El reflujo se define típicamente como un flujo sanguíneo retrógrado en las extremidades inferiores mayor de 0.5 s después de la provocación 2 , o > 0.5 s en venas superficiales y 1.0 s para venas profundas 3 ; así como acumulación de sangre en las venas profundas de las piernas. Además, la IVC puede favorecer úlceras crónicas de pierna y trombosis venosa profunda 2 .…”

“…La prevalencia de la IVC varía considerablemente entre los sexos, los orígenes étnicos y los grupos de edad, con un estimado entre el 5-65% 1,2,4 , donde el personal de enfermería representa un factor de riesgo alto para la presencia de venas varicosas 5 , principalmente por la bipedestación prolongada y el sexo predominantemente femenino.…”

“…En las piernas, los signos (telangiectasias, edema y cambios tróficos en la piel como eczema, hiperpigmentación e induración) y los síntomas (calambres, dolor, sensación de pesadez, ardor y fatiga) tienen diversos grados y formas de presentación 1,2 , lo cual puede afectar significativamente la calidad de vida y llevar a días de trabajo perdidos y ser una carga importante para los sistemas de salud 1,6 .…”

Class I compression therapy improves lower limb vascular flow volume in patients with chronic venous insufficiency – a magnetic resonance imaging study

“…Medical compression therapy is a linchpin in the treatment of CVI and class I compression stocking therapy is both well-tolerated and can significantly improve symptom severity [7,8]. However, to date, there have been no studies directly examining the effect of medical compression therapy on hemodynamically relevant parameters in CVI using MRI.…”