Thigh compression after great saphenous surgery is more effective with high pressure

Methods to compress thigh veins effectively after venous surgery or endovenous procedures are still disputed. The aim of this paper was to compare the clinical outcomes with three different compression devices as a function of the pressures exerted.

Fifty-four patients undergoing invagination stripping of the great saphenous vein and side branch evulsion under local anaesthesia were treated postoperatively in sequential order by 1) thigh length compression stockings; 2) adhesive bandages; and 3) newly developed eccentric compression pads fixed with tapes and a thigh length stocking on top. Sub-bandage pressures were measured at mid-thigh level under these devices after application and one week later before compression was removed. Pain, hematoma, bleeding through the bandage, discomfort and skin irritations were recorded and rated as major or minor adverse events.

The lowest sub-bandage pressure of around 15 mmHg at thigh level in the lying position were found in group A under the compression stockings, which nominally provide 23-32 mmHg at ankle level. Group B and group C showed significantly higher values (median values of 47 and 68 mmHg respectively in lying position, P<0.001). The median pressure values in the three groups upon standing were 16 mmHg, 63 mmHg and 98 mmHg. One week later there was a pressure-drop in the lying position in the three groups of 13%, 64%, and 46% respectively. Major adverse events were seen in a total of 10 of 18 patients in group A, in 1/18 in group B, and in 0/18 in group C. Minor adverse events in the three groups consisting mainly of light discomfort for compression devices and local skin irritations were observed in 6, 6 and 15 cases respectively.

The best results with respect to the reduction of pain and hematoma were obtained when eccentric compression pads were taped to the skin of the thigh and a compression stocking was worn on top. A possible explanation for these observations is the very high local pressures under the eccentric device.