Support stockings or Graduated Pressure Stockings and varicose veins?

There are several different names given to the support stockings that are often prescribed for people suffering from varicose veins or other venous conditions (phlebitis, venous eczema, haemosiderin deposition, leg ulcers). They are often called 'Medical Stockings' or are more properly called 'Graduated Pressure Stockings'.

They are very important for people with varicose veins or venous problems, but for several different reasons. In this page, I will explain how they work and who they are useful for - and who they are not useful for!!

Properly fitted support stockings

Firstly, and most importantly, support stockings will only be of any use at all if they fit. This sounds simple - but it is amazing how many people just get some 'off the shelf' and then are surprised that their legs don't feel better!

Firstly, support stockings can come as:

• below knee
• above knee (thigh length) - either hold-ups or with a suspender belt
• tights
  

Secondly, to get the right size, you need to either be measured properly by a trained professional or, if you need to, measure yourself. You will need to measure your ankle, calf and length as a minimum to get a proper fit.

Thirdly - there are different strengths (or grades) of stockings. Your doctor will tell you which you need for your specific condition.

Graduated pressure in support stockings

The reason for measuring the support stockings is to make sure that there is proper 'graduated pressure' on the leg from the support stocking.

Graduated pressure means that the pressure is greatest at the foot and ankle, and then eases off gradually the further up the leg the stocking goes.

This is for two reasons - firstly to encourage the blood flow back up the leg and secondly, to counter the inflammation caused by the refluxing blood in the varicose veins - which worsens the lower down the leg it goes.

Therefore, all support stockings should be graduated pressure stockings.

The use of support stockings to treat varicose veins

There has been a trend in the UK to refuse varicose vein surgery to patients unless they they have worn support stockings for 6 months and have 'failed to get better'.

Unfortunately, support stockings can never make varicose veins better. When someone with varicose veins is wearing properly fitted graduated pressure support stockings, the varicose veins are compressed and the venous reflux is reduced. However, the stockings do nothing to change the underlying condition and so, as soon as they are removed, the blood continues to reflux down the veins that have lost their valves and the damage to the skin or the growth of the varicose veins continues.

Therefore, at best, support stockings slow the deterioration of that varicose veins, but they never cure them and therefore are not a treatment for varicose veins.

The only way the veins can be cured permanently is to have a proper expert venous Duplex Ultrasound scan, and then have the new endovenous treatments as introduced and championed by The Whiteley Clinic.

So why are people refused treatment until they have 'failed to get better after 6 months with support stockings'? There is no scientific answer to this - one can only assume that there is some financial advantage in making patients delay their investigation and treatment by a further 6 months.

Treatment of venous eczema or leg ulcer with support stockings (or other compression)

Patients who have skin damage from venous reflux - ie: venous eczema, lipodermatosclerosis, haemosiderin (brown staining) or leg ulcers - all collectively and incorrectly called 'venous hypertension' - improve when wearing properly fitted graduated pressure support stockings.

Unfortunately, just as with varicose veins, any advantage to wearing the support stockings is lost as soon as the support stockings are removed.

The reason for this is fairly simple. The damage is caused by the venous reflux - blood falling down the veins without valves and hitting the vein walls at the bottom of the leg, causing inflammation of the skin and surrounding tissues.

Graduated pressure pushing on the skin from the outside reduces the blood falling down the leg and therefore reduces the inflammation caused by the venous reflux. Thus when wearing the support stockings, the skin damage is reduced and the skin can start to heal.

Unfortunately, as with varicose veins, nothing has changed inside the leg whilst wearing the support stockings and so as soon as the stockings are removed, the venous reflux starts once again and the deterioration continues.

As with varicose veins, the only chance of a permanent cure for these conditions is a specialist venous Duplex Ultrasound scan and then treatment using the new endovenous techniques that were introduced or championed by The Whiteley Clinic.

Support stockings after treatment of varicose veins

Although varicose veins have no role in the treatment of varicose veins by themselves (they only reduce the symptoms temporarily - see above), they can be very useful following venous treatments.

After EVLA (endovenous laser - see www.evla.co.uk) or RFA (radiofrequency treatment of the veins - see www.veins.co.uk under treatments) the support stockings are used to keep the varicose veins empty until the time for them to be removed by phlebectomy.

After sclerotherapy injections (foam sclerotherapy or microsclerotherapy) the veins need to be held shut for 14 days and nights to ensure a good result. Hence graduated pressure stockings are essential to hold the veins closed for the 2 weeks needed to make sure the veins scar away completely.

Summary of the use of support stockings in the treatment of varicose veins

Support stockings are of NO use to treat varicose veins or venous conditions - only specialised surgical intervention under Duplex control can give good long term improvements or cure.

However, they can improve the symptoms in the short term whilst they are being worn - but the deterioration continues as soon as they are removed.

Support stockings can be very useful to hold the veins closed after sclerotherapy for 14 days and nights or to reduce the risks of thrombophlebitis or bruising in veins that have had one procedure and in patients who are waiting for a second or third procedure in the same leg.