Knee-length versus thigh-length graduated compression stockings in the prevention of deep vein thrombosis

Abstract

Graduated compression stockings can reduce the incidence of deep vein thrombosis by 60 per cent1, by providing a decreasing compression gradient from the ankle towards the thigh. There is both theoretical and clinical evidence that compression of the thigh as well as the calf does not give extra benefit2,3. Although regarded as safe, improperly used stockings are not without risk. Problems are usually due to areas of localized high pressure, especially under ‘rucked up’ constricting bands of stocking. This is particularly so in the presence of ischaemia; manufacturers state that ischaemia is a contraindication to stocking use. Cases of arterial thrombosis have been reported4, as well as more frequent skin necrosis, when stockings have been used in the presence of reduced arterial blood supply5.

The Use of Knee-Length Versus Thigh-Length Compression Stockings and Sequential Compression Devices

“…This can actually impede circulation and increase DVT risk because of venous stasis. 6 These results are consistent with the prospective study of Hameed et al 9 that compared thigh-length versus kneelength compression stockings and that also identified the most common problem with fit of thigh-length stockings was the band effect when stockings were rolled down.…”

“…6,11 Substantial cost savings have been reported from the use of knee-length stockings and/or compression devices in comparison with thigh-length ones. 6 Hameed et al 9 stressed that knee-length stockings are more likely to be correctly applied than thigh-length stockings. Agu et al 12 argue that thigh-length stockings are more expensive, more difficult to put on, and less tolerated than knee-length stockings.…”

“…Also of concern was that thigh-length TEDS were being found applied improperly or rolled down with tight constricting bands on various parts of the leg, which can actually cause venous stasis and be harmful to patients. 6,7 Compression stockings and SCDs are available in thighlength and knee-length varieties, and the policy in our institution included use of both lengths.…”

A review of the evidence for the efficacy of Anti-Embolism Stockings (AES) in Venous Thromboembolism (VTE) prevention

“…In the major meta-analyses (Wells et al, 1994;Amarigi and Lees, 2000) evaluating the efficacy of AES, all the RCTs used thigh length stockings, except for two that did not specify the type of AES used (Turner et al, 1984;Allan et al, 1983) and one only used knee length stockings (Ohlund et al, 1983). Reports suggesting the equal efficacy of knee length and thigh length stockings have focused on venous blood flow and their acceptability and not on DVT prophylaxis (Williams et al, 1996;Hameed et al, 2002;Sajid et al, 2006;Brady et al, 2007). Although, there is evidence that venous blood flow velocity is similar in patients wearing knee length and thigh length stockings, the extent to which the maintenance of blood flow prevents DVT is not clearly understood (Laurence and Kakkar, 1980).…”

“…Several studies have challenged the evidence on preferential use of thigh length stockings. Sparrow et al (1995) and Williams et al (1996) claim that any compression above the tibial plateau has no added benefit over below knee compression, in relation to preventing venous stasis. They argue that increasing the compression at the thigh is likely to compromise performance further down the leg, as previously reported by Laurence and Kakkar (1980).…”