Hemodynamic assessment of high-compression hosiery in chronic venous disease

Graded high-compression support hosiery have long been recognized as a physiologically significant mode of therapy for chronic venous disease because of their effects on the hemodynamics of venous return. Photoplethysmography (PPG) in the noninvasive vascular laboratory is now recognized as a quick, simple, and noninvasive measurement technique, which correlates well with ambulatory venous pressure in the postphlebitic limb with chronic venous insufficiency. The purpose of this study was to evaluate the hemodynamic effects, as measured by PPG, of 40 mm Hg graded compression support hosiery in the treatment of patients with a documented history of hospital-treated thrombophlebitis. Fifty lower extremities among 38 patients with a documented history of deep vein thrombosis and chronic venous insufficiency were matched against 50 control extremities among patients without disease. All 50 lower extremities in the study group had abnormal noninvasive venous studies, including Doppler ultrasound examination, phleborheography, and PPG (mean, 5.9. seconds). Thus these patients were ascertained to have incompetent deep venous systems, but with normal arterial flow as documented by ankle:brachial ratios. After application of 40 mm Hg gradient compression stockings to the study group, PPG measurements in all 50 limbs initially converted to normal (20.6 seconds). Abnormal PPG measurements were converted to normal in postphlebitic limbs with the application of graded compression stockings in the 29 patients who wore the prescribed hosiery; 21 patients did not wear the gradient stockings after the initial evaluation(s) and were not found to have improved PPG measurements. It can be concluded that such gradient stockings should be associated with a reduction in ambulatory venous pressure, which may, in turn, lead to clinical prevention or improvement of the various sequelae associated with chronic venous hypertension.