Compression treatment in venous insufficiency and arterial disease

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, inelastic 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.