Acute effects of graduated and progressive compression stockings on leg vein cross-sectional area and viscoelasticity in patients with chronic venous disease

To determine the effects of graduated and progressive elastic compression stockings (ECS) on postural diameter changes and viscoelasticity of leg veins in healthy controls and in limbs with chronic venous disease (CVD). In 57 patients whose legs presented with C1S, C3, or C5 CEAP classes of CVD and treated primarily with compression, and 54 healthy controls matched for age and body mass index, we recorded interface pressures at 9 reference leg levels. Cross-sectional areas of the small saphenous vein (SSV) and a deep calf vein (DCV) were measured with B-mode ultrasound with subjects supine and standing, recording the force (PF) applied on the ultrasound probe to collapse each vein with progressive ECS, and with and without graduated 15‒20 mmHg and 20‒36 mmHg elastic stockings. We chose these veins because they were free of detectable lesion and could be investigated at the same level (mid-height of the calf), while their compression by the ultrasound probe was not hampered by bone structures. Interface pressures decreased from ankle to knee with graduated 15‒20 and 20‒36 mmHg, but increased with progressive ECS, and were 8.4‒13.8 mmHg lower for C1s than for control or C3 and C5 limbs. Without ECS, SSV median [lower‒upper quartile] cross-sectional area was 4.9[3.6‒7.1] and 7.1[3.0‒9.9]mm2 in C3 and C5 limbs vs. 2.9[1.8‒5.2] and 3.8[2.1‒5.4]mm2 in controls (p<.01), respectively while supine and standing. It remained greater in C3 and C5 than in C1S and control limbs wearing any ESC. Wearing compression, especially with progressive ECS, decreased SSV and DCV cross-sectional area only with subjects supine, thus lowering postural changes which remained highly diverse between individuals. The SSV cross-sectional area vs. PF function traced a hysteresis loop of which the area, related to viscosity, was greater in C3 and C5 limbs than controls, even with graduated 15‒20 or 20‒36 mmHg ECS. Progressive ECS lowered vein viscosity in the supine position whereas 20‒36 mm Hg and progressive ECS increased distensibility in the standing position. Elastic compression stockings reduce cross-sectional area of superficial and deep calf veins with patients supine but not upright. C1s limbs show distinctive features, especially regarding interface pressures. Graduated 20‒36 mm Hg and progressive stockings lower viscosity and increase distensibility of the small saphenous vein.