Risks and contraindications of medical compression treatment

Medical compression treatment with medical compression stockings (MCS), compression bandages (CB), or intermittent pneumatic compression (IPC) belongs to the basic treatment options in acute and chronic venous diseases and in lymphedema. In a recent international consensus paper, well-known experts in the field reviewed the recent literature on reported risks and recommended contraindications for elastic compression treatment. Results: Reported nonsevere adverse events (AEs) included skin irritation, allergic skin reaction, discomfort and pain, forefoot edema and lymphedema, and bacterial or fungal infections. Only skin irritations and discomfort and pain were reported commonly with an incidence between 1% and 10%. All reported severe AEs such as soft tissue damage and necrosis, nerve damage, arterial impairment, venous thromboembolism, and cardiac decompensation were reported very rarely with an incidence below 0.01%. The contraindications for compression treatment are: severe peripheral arterial occlusive disease (PAOD) with ankle brachial pressure index (ABPI) <0.6, ankle pressure <60 mm Hg, toe pressure <30 mm Hg, or transcutaneous oxygen pressure < 20 mm Hg; suspected compression of an existing epifascial arterial bypass; severe cardiac insufficiency (New York Heart Association [NYHA] class IV); routine application of MC in NYHA III without strict indication, and clinical and hemodynamic monitoring; confirmed allergy to compression material; and severe diabetic neuropathy with sensory loss or microangiopathy with the risk of skin necrosis. Conclusions: Compression treatment is a standard treatment in venous and lymphatic diseases. Most of the published AEs are caused by incorrect indication or application of the compression material. The contraindications must be respected to avoid severe complications.