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The guidelines contain information on the prevention and treatment of arterial hypotension during cesarean section under neuraxial anesthesia. Vasopressors, elastic compression of lower extremities, co-infusion of crystalloids, low doses of local anesthetics, lateral position, and ondansetron are proposed. A positive effect is achieved only through the joint application of preventive measures.

Erysipelas, a variant of cellulitis, is a superficial dermal bacterial infection. This superficial cutaneous infection may cause lymphangitis with resultant lymphedema in poorly treated cases. Reports of erysipelas preceding lymphedema are rare, rather many have reported the occurrence of erysipelas in patients with subclinical or overt lymphedema. Two case reports of erysipelas preceding lymphedema after appropriate parenteral antibiotics therapy and limb elevation are here presented. Following diagnosis, admission, and commencement of therapy, the second patient (Case 2) discontinued hospital treatment halfway for native treatment and returned after about 3 weeks. All patients recovered successfully but later presented with lymphedema after 8 weeks and 6 weeks, respectively. Both patients made a sustained functional recovery of their limbs with conservative management including elastic compression stocking and limb elevation. Erysipelas infection preceding lymphedema may develop when it occurs, prompt and appropriate treatment modalities for erysipelas infection may forestall the development of lymphedema.

Introduction/Objective. The objective of the paper is an assessment of the effect of graduated elastic compression stockings on clinical findings, complications, and inflammatory and thrombotic markers in patients with superficial vein thrombophlebitis. Methods. This prospective study was conducted between January and July of 2017, at the Clinic for Vascular and Endovascular Surgery of the Clinical Centre of Serbia. All the patients were clinically examined, and color duplex ultrasonography of the superficial and deep venous systems was performed. In all cases, we follow clinical finding, inflammatory and thrombotic markers, and superficial vein thrombosis (SVT) complication. Results. SVT was detected in 60 patients (36 women, aged 23?75 years and 24 men, aged 18?76 years. Most patients were with unilateral, subacute, above-knee located SVT. Regarding the typical clinical symptoms of SVT, patients were divided into four groups. The majority of our patients (group D) had all the symptoms associated. Regarding the severity of SVT and risk factors, the patients were divided into a greater risk group (Group I) and a lesser risk group (Group II), and treated with low-molecular-weight heparin, aspirin and two classes of graduated elastic compression stockings regarding the level of SVT. Laboratory testing of inflammatory and thrombotic markers in patients with SVT was performed at the beginning and at the end of therapy. Conclusions. In treatment of SVT, higher class of graduated compression therapy has stronger influence in decrement of inflammatory and thrombotic factors and prompt and adequately chosen therapy of SVT allows stoppage and regression of the thrombotic process.

Symptoms of chronic venous insufficiency have been known since antiquity. The prevalence of chronic venous insufficiency in Western Europe and the USA has been reported within the range from from 1 to 40% in women and from 1 to 17% in men [1]. As reported by the European authors, the average prevalence of chronic venous insufficiency with class C2-C6 (according to the CEAP classification) among the European population reaches 30% [2]. Edema syndrome remains one of the leading manifestations of chronic venous disease. Compression therapy is one of the main ways to combat edema. The arsenal of devices for the treatment of edematous syndrome is steadily expanding with the development of medical science. Today, in addition to inelastic compression wrap and elastic compression garments, brand-new compression products, circaid adjustable inelastic compression wraps are available.

ObjectivesElastic compression stocking (ECS) therapy is an important treatment for patients with deep venous thrombosis (DVT) and chronic venous insufficiency (CVI). This study aimed to provide insight into the structure and variability of the ECS therapy process, its effects on outcomes, and to elicit improvement themes from a multiple stakeholder perspective.DesignThirty semi-structured interviews with professionals and patients were performed. The essential functions for the process of ECS therapy were extracted to create two work-as-done models using the Functional Resonance Analysis Method (FRAM). These findings were used to guide discussion between stakeholders to identify improvement themes.SettingTwo regions in the Netherlands, region Limburg and region North-Holland, including an academic hospital and a general hospital and their catchment region.ParticipantsThe interviewees were purposely recruited and included 25 healthcare professionals (ie, general practitioners, internists, dermatologists, nurses, doctor’s assistants, occupational therapists, home care nurses and medical stocking suppliers) and 5 patients with DVT or CVI.ResultsTwo FRAM models were created (one for each region). The variability of the functions and their effect on outcomes, as well as interdependencies between functions, were identified. These were presented in stakeholder meetings to identify the structure of the process and designated variable and uniform parts of the process and its outcomes. Ultimately, six improvement themes were identified: dissemination of knowledge of the entire process; optimising and standardising initial compression therapy; optimising timing to contact the medical stocking supplier (when oedema has disappeared); improving the implementation of assistive devices; harmonising follow-up duration for patients with CVI; personalising follow-up and treatment duration in patients with DVT.ConclusionsThis study provided a detailed understanding of how ECS therapy is delivered in daily practice by describing major functions and variability in performances and elicited six improvement themes from a multistakeholder perspective.

The settlement calculation of postgrouting piles is complex and depends on the calculation method and parameters. Static load tests were conducted to compare the settlement characteristics of nongrouting and postgrouting piles, and three vital parameters in the layer-wise summation method were revised to predict the settlement of postgrouting piles. The elastic compression coefficient was deduced based on the Mindlin–Geddes method by considering the influence of the change in the pile side resistance distribution and end resistance ratio on the elastic compression after grouting. The relationship between the compression modulus and soil gravity stress and cone penetration resistance were established, respectively, using experimental data. The optimum value of the settlement empirical coefficient was determined using regional data. Finally, we used the postgrouting pile of the Wuqi–Dingbian expressway as a practical example. The results obtained from the layer-wise summation method after parametric optimization were close to the measured values. The results of this study provide reference data and guidance for the settlement calculation of postgrouting piles in this area.

Background: Elastic compression stockings (ECS) are uncomfortable to wear but may prevent post-thrombotic syndrome (PTS). The ability to predict PTS may help clinical decision making regarding the optimal duration of ECS after deep vein thrombosis (DVT). Aims: Predefined endpoint analysis of the Octavia study that randomized patients who compliantly used ECS up to one year after DVT to continue or discontinue ECS treatment. Primary aim was to identify predictors of PTS. Methods: Patient characteristics were collected and ultrasonography was performed to assess reflux, residual thrombosis and persistent thrombus load 12 months after DVT. Multivariable analyses were performed to identify factors related to PTS. Results: Thrombus score ≥ 3, BMI ≥ 26, duration of symptoms before DVT diagnosis ≥ 8 days and a Villalta score of 2–4 points were statistically significant predictors of PTS. The predictive value for PTS for the assessed variables was not different between the 2 treatment groups. In the stop ECS group, 3.2% (95%CI 0.08–18) of patients without any predictors for PTS were diagnosed with mild PTS during follow-up, and none with severe PTS, for a sensitivity of 98% (95% CI 89–100), a specificity of 14% (95% CI 10–20), a positive predictive value of 20% (95% CI 19–22), and a negative predictive value of 97% (95% CI 81–100). Conclusion: We identified 4 predictors of PTS occurring in the 2nd year after DVT. Our findings may be used to decide on whether to continue ECS treatment for an additional year, after one year of compliant ECS use, keeping in mind that patients with none of the predictors will have the lowest PTS incidence.

Venous leg ulcers (VLUs) are a major health problem because of their high prevalence and associated high cost of care. Despite the widespread use of compression, treatment recurrence rates remain high. Numerous studies have suggested that regular use of compression stockings reduces VLU recurrences. However, there are limited data concerning how long compression hosiery should be worn after ulcer healing and which class of compression hosiery achieves better results in the prevention of VLU recurrences.An open, prospective, randomized, single-center study with a 5-year follow-up was performed to establish the efficacy of two different strengths of knee-high compression hosiery (class 2 and class 3) in the prevention of VLU recurrences. The study included patients with recently healed venous ulcers and no significant arterial disease, rheumatoid disease, diabetes mellitus, and restriction in range of ankle movement. Overall, 361 patients were randomized, and 308 patients (170 men, 138 women; mean age, 59 years) completed the study. Patients were randomized into two groups: group A, 186 patients who wore a heel-less open-toed elastic class 3 compression device knitted in tubular form (Tubulcus; Laboratoires Innothera, Arcueil, France); and group B, 175 patients who wore a class 2 elastic stocking (Rudo, Nis, Serbia). All patients were instructed to wear compression stockings continuously for the first 2 years of follow-up (both during the day and at night). In the third, fourth, and fifth years of follow-up, patients were instructed to wear elastic stockings during the day only. The main outcome measures were recurrence of leg ulceration and compliance with the treatment.Rates of ulcer recurrence after the 5 years of follow-up were 28.98% for the compression class 3 group and 60% for the compression class 2 group (P .001, log-rank test). Patients in the compression class 3 group experienced significantly longer absolute (46 vs 40 months; P .001, Mann-Whitney U test) and proportional (77% vs 67%; P .001, Mann-Whitney U test) ulcer-free time after 5 years than those in the compression class 2 group. Rates of noncompliance after 5 years were 10.23% for the compression class 3 group and 6.25% for the compression class 2 group (P = .188, χThe results obtained in this study suggest that class 3 compression stockings provide a statistically significant lower recurrence rate compared with the class 2 compression stockings.

Introduction Endogenous bioelectric fields (EBFs) play a fundamental role in promoting repair and regeneration processes, including in leg venous ulcers (LVUs). Unfortunately, the mechanism underlying the production of EBFs is easily altered by infectious, traumatic, and epigenetic factors. This alteration is one of the determining factors for the chronicity of LVUs. This study investigates how radioelectric asymmetric conveyer (REAC) technology treatments, specifically designed to optimize EBFs, and in particular tissue optimization-reparative (TO-RPR) treatment, can improve the results of standard dressing with and without elastic compression in LVU patients. Methods A total of 30 patients were enrolled (12 males and 18 females) and randomized into three groups. All patients completed the study. Group A was treated with standard dressing, elastic compression, and REAC TO-RPR treatment; Group B was treated with standard dressing and REAC TO-RPR treatment; and Group C was treated with standard dressing and elastic compression. Results The results show that the combination of REAC treatment and standard dressing associated with elastic compression has the greatest therapeutic efficacy in promoting the healing process for ulcers, reducing perceived pain, and improving the quality of life of the patients treated. Conclusions Further studies will be useful to investigate these prospective results.

BACKGROUND: Compression bandages often are used after TKA to reduce swelling. However, the degree to which they are helpful has not been well characterized. QUESTIONS/PURPOSES: The purpose of this study was to determine whether use of a compression bandage after TKA was associated with (1) less leg swelling (our primary endpoint); or (2) secondary study endpoints, including improved ROM of flexion and extension, lower visual analog scale (VAS) pain scores for worst pain and pain during physical therapy just before surgery, postoperative day (POD) 1, POD 2, and POD 28, or fewer wound complications within 90 days of surgery. METHODS: A prospective, single-center, two-arm, parallel-group randomized controlled trial was conducted on 51 patients undergoing simultaneous, bilateral, primary TKA between February 2015 and August 2016. Patients were excluded if they had a body mass index > 40 kg/m(2), a history of a venous thromboembolic event, an allergy to the dressing or compression bandage, or lymphedema in one or both legs. Participants averaged a mean age of 62 years (range, 40-83 years). In all patients, we released the tourniquet after full wound closure, and we applied an Aquacel dressing to both limbs. Patients were randomized by opaque envelope, and the compression bandage was applied to the randomized limb. For each leg, study personnel not involved in patient care measured the patients’ limb circumference (thigh, knee, and tibia), ROM, and VAS pain scores 24 hours after surgery, 48 hours after surgery, and on POD 28. The minimal clinically important difference for circumference was 2 cm with a SD of 2 cm in the circumference. For VAS, it was 2 points with a SD of 2. For ROM, it was 10° with a SD of 15. We conservatively picked an effect size of 0.5 SD and assumed a correlation between limbs of 0.3. This set the power level at 0.80 with an α error of 0.05; thus, a power analysis for paired t-tests indicated that 45 patients would be an appropriate sample size. There were 29 patients randomized to the right leg group and 22 patients randomized to the left leg group. There were no differences between the limb with and without the compression bandage preoperatively. RESULTS: Postoperatively, there were no differences between the groups in terms of leg swelling at the thigh (POD 1: mean ± SD = 51 ± 6 with compression bandage versus mean ± SD = 51 ± 6 without compression bandage, mean Δ = - 0.14, 95% confidence interval [CI], -0.65 to 0.37], p = 0.586; POD 2: mean ± SD = 53 ± 6 with compression bandage versus mean ± SD = 53 ± 7 without compression bandage, mean Δ = -0.22, 95% CI, -0.95 to 0.51, p = 0.548; POD 28: mean ± SD = 47 ± 6 with compression bandage versus mean ± SD = 47 ± 6 without compression bandage, mean Δ = -0.01, 95% CI, -0.39 to 0.38, p = 0.975), knee (POD 1: mean ± SD = 45 ± 4 with compression bandage versus mean ± SD = 45 ± 5 without compression bandage, mean Δ = -0.44, 95% CI, -1.16 to 0.28, p = 0.223; POD 2: mean ± SD = 46 ± 4 with compression bandage versus mean ± SD = 46 ± 4 without compression bandage, mean Δ = -0.30, 95% CI, -0.69 to 0.10, p = 0.137; POD 28: mean ± SD = 42 ± 5 with compression bandage versus mean ± SD = 42 ± 5 without compression bandage, mean Δ = 0.21, 95% CI, -0.34 to 0.76, p = 0.446), and shin (POD 1: mean ± SD = 40 ± 4 with compression bandage versus mean ± SD = 40 ± 4 without compression bandage, mean Δ = -0.22, 95% CI, -1.23 to 0.79, p = 0.659; POD 2: mean ± SD = 41 ± 4 with compression bandage versus mean ± SD = 41 ± 4 without compression bandage, mean Δ = -0.31, 95% CI, -0.72 to 0.09, p = 0.126; POD 28: mean ± SD = 37 ± 4 with compression bandage versus mean ± SD = 37 ± 4 without compression bandage, mean Δ = -0.34, 95% CI, -0.92 to 0.24, p = 0.246). There were no differences between the groups in terms of flexion ROM (POD 1: mean ± SD = 56 ± 25 with compression bandage versus mean ± SD = 58 ± 22 without compression bandage, mean Δ = -2.63, p = 0.234; POD 2: mean ± SD = 64 ± 20 with compression bandage versus mean ± SD = 63 ± 23 without compression bandage, mean Δ = 1.22, p = 0.534; POD 28: mean ± SD = 101 ± 20 with compression bandage versus mean ± SD = 102 ± 20 without compression bandage, mean Δ = -1.64, p = 0.103) and extension (POD 1: mean ± SD = 12 ± 7 with compression bandage versus mean ± SD = 12 ± 7 without compression bandage, mean Δ = 0.51, p = 0.328; POD 2: mean ± SD = 9 ± 5 with compression bandage versus mean ± SD = 10 ± 6 without compression bandage, mean Δ = -1.28, p = 0.061; POD 28: mean ± SD = 6 ± 14 with compression bandage versus mean ± SD = 4 ± 4 without compression bandage, mean Δ = 2.19, p = 0.252). With the numbers available, we observed greater maximal postoperative pain for the limb with the compression bandage than the control limb on POD 1 and POD 2, but not on POD 28 (POD 1: mean ± SD = 8 ± 3 with compression bandage versus mean ± SD = 7 ± 3 without compression bandage, mean Δ = 0.66, p = 0.030; POD 2: mean ± SD = 7 ± 2 with compression bandage versus mean ± SD = 7 ± 3 without compression bandage, mean Δ = 0.80, p = 0.008; POD 28: mean ± SD = 4 ± 3 with compression bandage versus mean ± SD = 3 ± 3 without compression bandage, mean Δ = 0.14, p = 0.526). Likewise, there was greater pain during physical therapy for the limb with the compression bandage than the limb without on POD 2, but not on POD 1 and POD 28 (POD 1: mean ± SD = 7 ± 3 with compression bandage versus mean ± SD = 6 ± 3 without compression bandage, mean Δ = 0.29, p = 0.460; POD 2: mean ± SD = 8 ± 2 with compression bandage versus mean ± SD = 7 ± 3 without compression bandage, mean Δ = 0.67, p = 0.018; POD 28: mean ± SD = 5 ± 2 with compression bandage versus mean ± SD = 5 ± 3 without compression bandage, mean Δ = 0.14, p = 0.600). With the numbers available, we observed no difference in 90-day wound healing complications between the limb with and the limb without the compression dressing; however, the sample size was too small to analyze this in a meaningful statistical way. Overall, there were 6% total wound complications in the compression bandage group and 12% total wound complications in the group without the compression bandage (odds ratio [OR], 0.47; p = 0.487). Drainage was not observed in the group with the compression bandage, whereas the group without the compression bandage had 6% drainage (OR, 0.00; p = 0.243). There were no deep infections or reoperations within 90 days postoperatively. CONCLUSIONS: Applying a compression bandage after TKA did not result in any clinical improvement in limb circumference, ROM, or pain. Based on this study, we believe that applying a compression bandage after TKA neither benefits nor harms the patient. Thus, we no longer use compression dressings for routine primary TKA. LEVEL OF EVIDENCE: Level I, therapeutic study.

Compression garments are extensively used for various therapeutic treatments and are expected to deliver accurate and reproducible compression pressures. This study focuses on developing an analytical model to predict the pressure generation by compression garments on human limb analogues. The analogues consisted of non-compressible and compressible cylinders that were chosen as the first step towards evaluating pressure generation on real human limbs. An experimental platform was developed to quantify the relationship between material properties, initial garment extension and pressure. A mathematical model was presented that provided greater accuracy in predicting the pressure generated by compression garments than the existing Young-Laplace equation for compressible limb analogues.

Introduction: Elastic compression stockings (ECS) are commonly used for the prevention of post-thrombotic syndrome (PTS) after deep venous thrombosis (DVT). However, their efficacy is controversial. While two open-label studies reported a 50% risk reduction of PTS in the ECS vs. no-ECS groups, a large double-blind study didn't find any benefit of ECS vs. placebo-ECS to prevent PTS. These opposite results could be explained either by a placebo effect in the open-label studies or to a lack of compliance to study ECS in the double-blind study. Additional data on the impact of compliance on ECS efficacy, obtained in a double-blind way, are therefore needed. Methods: We analyzed data from the French, CELEST, multicentre double-blind trial comparing 25mmHg ECS vs. 35mmHg ECS to prevent PTS at 2 years after a first symptomatic ipsilateral proximal DVT (NCT01578122). All CELEST patients who had complete data for primary outcome (i.e. PTS, defined as a Villalta score ≥5 on the DVT affected leg at the one- or 2-year follow up visit) were included. The objectives of this predefined analysis were to: i) compare the incidences of PTS at 2 years according to compliance to ECS (irrespective of allocated treatment group) during the first 3 months of treatment and during the 2-year follow-up; ii) assess independent predictors of PTS using a stepwise multivariable model including all of the following variables (baseline patients' and DVT characteristics, anticoagulant treatment and compliance to ECS) if they achieved a p value of 0.2 or less in univariate analysis as well as ECS strength allocation group; iii) build an induction tree algorithm to measure the impact in terms of incidence of PTS of each of the independent predictor of PTS. Compliance to ECS was defined as reasonable and optimal if the patient had worn the study ECS more than 50% and more than 80% of the time respectively and had a modified GIRERD score of 0-2. Results: 249 patients were eligible for this analysis. Mean baseline age was 57 years, 70% (n=174) were men, 20% (n=50) were obese, 21% (n=52) had previous VTE event, 7% (n=18) had a baseline Villalta score ≥5 and the most proximal extent of DVT was the iliac vein in 15% (n=37) of cases. In 80% (n=179) of cases patients were treated with anticoagulation for more than 6 months after DVT and a direct oral anticoagulant (DOAC) was used in 69% (n=164) of cases. 32 % (n=80) of patients developed PTS at 2 years. When patients wore study ECS>80% of the time (i.e optimal compliance), incidence of PTS over 2 years was 26.1% (n=31). Incidence of PTS was 25.0% (n=10) and 40.5% (n=34) in those patients who wore ECS 50-80% and Conclusions: In our double bling study assessing 25mmHg vs. 35mmHg ECS to prevent PTS, compliance to ECS was a significant independent predictor of PTS in our multivariable model. Impact of ECS use became apparent when patient used ECS at least 50% of the time without any strong benefit beyond. Wearing study ECS>50% of the time was associated with 2-fold decreased risk of developing PTS, which is consistent with the results from previous 'positive' open-label studies. It suggests that use of ECS influences the risk of developing PTS. Our induction tree algorithm evidences that being compliant with ECS seems particularly beneficial in - non-obese - patients with extensive DVT. Figure 1 Figure 1. Disclosures Verriere: Laboratoires Innothera: Current Employment.

Objective. The aim of the work is to improve the results of complex conservative treatment of elderly and senile patients with trophic ulcers of the lower extremities on the background of chronic venous, cardiovascular insufficiency and type II diabetes mellitus with the use of adjuvant general and local pharmacotherapy in a general practice and family medicine outpatient setting. Materials and methods. The paper presents ten years of conservative treatment 834 patients (of them: in working age – 209, in the elderly and senile – 625), the trophic ulcers of the lower limbs and other venous etiology in a district hospitals (2007-2012) and in ambulatory general practice and family medicine (2013-2016), using a common adjuvant treatment Oregon protocol based (1999) and locally – ointment medical dressings, including Unna's boot, carefully principle of motion phases of wound healing, and the use of medical daily elastic compression. Result. Ulcers with a diameter of 2 to 5cm (344) treatment to complete epithelialization was between 2 to 5 weeks; and ulcers in diameter from 6 to 9 cm (179), he was 6-10 weeks. Thus, in 31 patients healing took place under the bandage Unna's boot and in 59 patients with ulcers with a diameter of 10 cm treatment periods were 15-18 weeks, with repeated use of Unna's boot. In 44 (7 %) treated patients with recurrent ulcers occurring due to violation of compression therapy. Conclusion. Thus, the use of above mentioned treatment, taking into account current phases of wound healing, and medical daily elastic compression makes it possible to get a 93 % sustained therapeutic effect.

At present, the technology of strengthening bridge with prestressed CFRP bars is gradually rising, so it is necessary to study the law of prestress loss. In order to evaluate the short-term prestress loss of prestressed carbon fiber reinforced (CFRP) bars, the prestress loss of CFRP bars used for reinforcement of reinforced concrete beams was studied by combining laboratory tests with practical reinforcement projects. The anchorage loss, concrete elastic compression loss of CFRP bars were obtained by measuring the prestressed loss data of CFRP bars used to strengthen retired old beams and corresponding theoretical calculation. Then, combined with the corresponding loss data of 6 prestressed CFRP bars in the actual strengthening project of Wenzhou Lijing Middle Bridge, the experimental investigation was carried out. The results show that the prestress loss of CFRP bars is between 4%∼8%, and develops rapidly in the early stage, among which the anchorage loss accounts for 45.90%. The anchorage retraction value is about 1.33mm, and the elastic compression loss of concrete is basically negligible.

The Technical Regulations acting at present time on the highspeed lines construction has severe requirements to the quality of the railway embankments construction. They have to be practically without settlement and work at the stage of the elastic deformations. The purpose of this investigation is to study the process of soils compaction under repeated loads applications, which should have the amplitude- frequencies parameters such as produced by the highspeed running trains. Therefore, a special dynamic triaxial test apparatus was used for the laboratory investigation. The major features of this apparatus were to simulate the wave forms of the vibrations initiated by passing trains. The equipment and experimental procedure are described herein, as well as main results of testings. The first part of the report devoted to the theoretical substantiation of the possibility of the railway embankments construction without settlements. In the second part, the dynamic triaxial tests of the clay soils initially subjected to the elastic compression are described. The character of the void ratio changing during the dynamic elastic compression as compared with the static compression as well as the strength of the soils changing are shown. As the results, the method of compaction of the embankments to be applied during the new highspeed railroads construction is proposed.

Objective: To comprehend every day of older people with venous insufficiency, who use elastic compression socks. Methods: Phenomenological research that interviewed 13 elderly attended Basic Health Units in the state of Minas Gerais, between November 2017 to January 2018. The depositions were organized in categories and discussed according to the Alfred Schütz social phenomenology and theme literature. Results: Emerged from the interviews that make explicit the perspective of the participants regarding their everyday activities with compression elastic socks: “main symptoms of the venous insufficiency relieved”, “adversities that permeate the use of elastic compression socks” and “long term use of compression elastic socks”. Conclusion: For elderly people with chronic venous insufficiency, the use of elastic compression socks promotes relieve of the symptoms; however, it demands help to put them on and take them off and provokes heat sensation and discomfort in the limbs. The elderly showed the expectation to continue the long term use of the elastic sock aiming at avoiding the relapse of varicose ulcer. To validate the adversities related to the use of this compression device may help the elderly to broaden their autonomy and functional capacity, which may be compromised by venous insufficiency.

Venous thromboembolism (VT) has always attracted the attention of the scientific community as one of the most common causes of acquired morbidity and mortality in hospitalized patients. The objective of VT prophylaxis protocols is mostly aimed at preventing deep vein thrombosis (DVT) and pulmonary embolisms (PE). Their incidence may in fact be as high as 20% to 40% in high-risk populations, such as polytraumatized and critically ill patients (1). Although low-dose subcutaneous unfractionated heparin (UFH) or low molecular-weight heparin (LMWH) are estimated to reduce VT incidence by 50% (2), several studies (3-5) have demonstrated that mechanical prophylaxis with elastic compression and intermittent pneumatic compression (IPC) can further reduce the incidence of DVT/PE, and are widely advocated in at risk patients.

Nonostante i recenti progressi in tema di wound care, le ulcere varicose degli arti inferiori restano un problema frequente, con un alto tasso di recidiva. In questo lavoro abbiamo esaminato la storia clinica, la storia chirurgica e le patologie associate di 133 pazienti affetti da ulcera varicosa degli arti inferiori, di cui 56 da ulcera recidiva o plurirecidiva. L’analisi dei fattori di rischio potenziale per recidiva ha evidenziato come la presenza di varici recidive, una pregressa trombosi venosa profonda, problemi ortopedici, interventi ortopedici, l’obesità e un’età inferiore a 60 anni siano fattori di rischio potenziale per una recidiva dell’ulcera. La combinazione di uno più fattori di rischio assume significatività per la possibilità di una recidiva; si passa dal 22,7% in assenza di fattori di rischio al 33% per i pazienti che ne presentano due, fino al 57,5% in presenza di tre fattori di rischio e all’81,3% per quattro o più. L’ulcera varicosa richiede un follow-up stretto del paziente e una terapia elastocompressiva continua, che deve vedere una stretta collaborazione del paziente e un’attenzione specifica ai fattori di rischio. Despite recent advances in wound care, varicose ulcers of lower limbs remain frequent and display a high rate of recurrence. In this paper, we examined the clinical, surgical histories and associated diseases of 133 patients with venous ulcers of the lower limbs, which were recurrent in 56 cases. The analysis of potential risk factors for recurrence showed that the presence of recurrent varicose veins, a previous deep venous thrombosis, orthopedic problems, previous orthopedic procedures, obesity and age lower than 60 are potential risk factors for ulcer recurrence. Furthermore, the association of one or more risk factors increased the likelihood of relapse, from 22.7% with no risk factors to 33% with 2 risk factors, up to 57.5% with 3 risk factors, and up to 81.3% with 4 risk factors or more. Venous ulcers require close follow-up and continuous elastic compression, close collaboration by the patient and specific focus on risk factors.

The piezoresistance effect has been investigated in compensated and thermally treated samples of Si : Zn and Si : Zn, Mn under a uniaxial elastic compression. This effect is shown to be caused by changes in the concentration and mobility of current carriers. The anomalous change in the carrier mobility under the compression along crystallographic axis [111] is connected with a change in their scattering on large-scale defect formations., Ефект п’єзорезистентностi дослiджено в компенсованих та термiчно оброблених зразках Si : Zn i Si : Zn, Mn при одновiсному пружному стискуваннi. Показано, що цей ефект зумовлений змiнами концентрацiї та рухливостi носiїв струму. Аномальнi змiни рухливостi носiїв при стиску навколо кристалографiчної осi [111] пов’язанi зi змiною їх розсiювання на великомасштабних утвореннях дефектiв.

The purpose of this study was to identify the effects of the application of elastic compression stockings and lower extremities exercise on edema and pain of lower extremities in hospital nurses. The participants were 30 hospital nurses working at a general hospital. The participants were categorized into three groups such as, 10 for an experimental group of the application of the elastic compression stocking, 10 for another experimental group of the application of Lower extremities exercise and 10 for a control group. Edema of the lower extremities were measured in terms of the girths of ankles and calves. And pain of the lower extremities were measured in terms of the score by NRS(Numerical Rating Scale). The data were analyzed with Frequency, Percentage, Mean, Standard Deviation, -test and ANOVA to identify the participants' characteristics, SPSS Win 21.0 program was used for analysing. There are significant differences in lower extremity edema among the experimental group of lower extremities exercise, experimental group of elastic compression stocking and control group was supported(Rt Calf F=0.645, p=.000, Lt Calf F=21.941, p=.000). There are significant differences in lower extremity pain the experimental group of lower extremities exercise, experimental group of elastic compression stocking and control group was supported(Rt: F==7.320, p=.000 Lt: F=10.623, p=.000). In conclusion, in has been appeared that the lower extremities exercise and wearing elastic compression stocking have effedted in relieving low extremity edema and pain scale for nurses.

The study aims to explore the comprehensive reasons for patients' non-compliance with graded elastic compression stockings (GECS) as the treatment for lower limb varicose veins. Phenomenological analysis was applied in this qualitative study. The patients diagnosed with lower limb varicose veins and undergoing elective surgery who showed non-compliance with GECS as the treatment were invited to have semi-structured, in-depth, face-to-face interviews. Colaizzi method was employed to analyze the data for emerging themes associated with the reasons for patients' non-compliance. Four main themes and nine subthemes related to the reasons for non-compliance with GECS for lower limb varicose veins were summarized. The main themes that emerged were (1) gaps in the knowledge of GECS therapy as a treatment for lower limb varicose veins, (2) few recommendations from the doctors and nurses, (3) disadvantages of GECS, and (4) sociopsychological factors. These themes provide data for policy and planning to improve patients' compliance with GECS in China. Patients, healthcare professionals, and policy makers should share the responsibility to improve patients' compliance with GECS therapy.

Not available

Objective: to validate an algorithm for the choice of the abdominoplasty surgical technique among the five approaches established in the literature, according to the characteristics of the abdominal wall. Methods: we conducted a retrospective study of 245 patients undergoing abdominoplasty, for whom the method of choice of the surgical technique was the proposed algorithm, based on the degree of abdominal flaccidity determined by bimanual maneuver. We studied its applications and conveniences, as well as the complications inherent in each group studied. Results: according to the algorithm used, the most frequently chosen technique was “Technique IV” (transverse dermolipectomy of Pitanguy - or with a Baroudi-Kepke incision), in 25.71% of the cases. “Technique I” (mini abdominoplasty) had the lowest incidence and the lowest rate of complications. On the opposite, “Technique III”, dermolipectomy with remaining vertical scarring, presented a higher incidence of complications, requiring extreme caution in its indication, particularly in relation to patients’ expectations regarding the resulting scar and its legal aspects. Among all conducts, the most frequent complication was seroma, with a 10.2% occurrence, solved by simple syringe aspiration and use of elastic compression mesh. Conclusion: the proposed algorithm facilitated the choice of abdominoplasty techniques, offering satisfactory results, which are in line with the complication rates published in the world literature. RESUMO Objetivo : validar um algoritmo para a escolha da técnica cirúrgica de abdominoplastia, entre as cinco abordagens consagradas na literatura, de acordo com as características da parede abdominal. Método: estudo retrospectivo de 245 pacientes submetidos à abdominoplastias, em que o método de escolha da técnica cirúrgica teve como ferramenta o algoritmo proposto, baseado no grau de flacidez abdominal determinado por manobra bimanual. Foram estudadas suas aplicações e conveniências, bem como identificadas as complicações inerentes a cada grupo estudado. Resultados: de acordo com o algoritmo empregado, a técnica mais frequentemente eleita foi a “Técnica IV” (dermolipectomia transversa à Pitanguy - ou com incisão de Baroudi-Kepke), em 25,71% dos casos. A “Técnica I” (miniabdominoplastia) demonstrou a menor incidência e a menor taxa de complicações. A “Técnica III”, dermolipectomia com cicatriz vertical remanescente, ao contrário, apresentou maior incidência de complicações, requerendo extrema cautela na sua indicação, particularmente frente às expectativas dos pacientes quanto à cicatriz resultante e seus aspectos legais. Entre todas as condutas, a complicação mais frequente foi o seroma, com 10,2% de ocorrência entre os 245 casos operados, resolvido pela simples aspiração com seringa, e uso de malha compressiva elástica. Conclusão: o algoritmo proposto contribuiu para facilitar a escolha das técnicas na abdominoplastia, oferecendo resultados satisfatórios, que se alinham com as taxas de complicações publicadas na literatura mundial.

Background. Elastic compression stockings (ECS) are effective in preventing and reducing occupational edema (OE), but the optimal pressure according to the prevalent working position during the day is still controversial. Objective. To compare the effectiveness of ECS with different pressures (15–20 mmHg or 20–30 mmHg) for reducing OE in individuals working in different prolonged postures. Methods. This cross-sectional study comprised 116 lower limbs of 58 individuals divided into three groups according to their prevalent postures over the day (sitting, standing, or combination). Volumetric measurements were taken at the beginning and at the end of three consecutive days. On the first day, individuals did not use compression stockings; on the second and third days, they used, respectively, 15–20 mmHg and 20–30 mmHg knee-length stockings. Differences between morning and evening volumes (measured edema) were calculated, compared, and correlated. Results. Volumetric variations were significantly lower on the second compared to the first day when individuals in all three groups used 15–20 mmHg compression stockings (p-value < 0.001). Measurements were even lower when they used 20–30 mmHg stockings: this decrease was more significant for the sitting (p-value < 0.001) than the standing (p-value < 0.05) and combined groups (p-value < 0.05). Reduction of measured edema was more significant in individuals working in a prolonged seated position. No significant difference was found only on comparing sitting and standing groups after the use of the 15–20 mmHg compression stockings. Conclusions. The use of ECS over a working day reduces OE in prolonged sitting, standing, and combined positions, with the reductions being greater with the higher pressure.

International audience; Compression therapy with stockings or bandage is the most common treatment for venous or lymphatic disorders. The objective of this study was to investigate the influence of bandage mechanical properties, application technique and subject morphology on the interface pressure, which is the key of this treatment. Bandage stretch and interface pressure measurements (between the bandage and theleg) were performed on 30 healthy subjects (15 men and 15 women) at two different heights on the lower leg and in two positions (supine and standing). Two bandages were applied with two application techniques by a single operator. The statistical analysis of the results revealed: no significant difference in pressure between men and women, except for the pressure variation between supine and standing position; a very strong correlation between pressure and bandage mechanical properties (p

Background: The objective of this study is to investigate the effectiveness of medium pressurized elastic compression stockings usage after isolated vena saphena parva stripping. Material and Methods: Between 2001 January2014 March, 60 patients (40 women, 20 men, mean age; 39± 11 years, 35 to 58 years range) treated with vena saphena parva ligation and total stripping for isolated vena saphena parva insufficiency, were enrolled in this retrospective study. Elastic bandage applied postoperatively. Patients were divided into two groups according to use of additional compression stocking for 4 weeks; as stockings using group, (group 1; 18 women, 12 men, mean age 35±12.2, 23 to 47 years) and as no stockings using group, (group 2; 22 women, 8 men, mean age 38±10.8, 27 to 49 years) and. Primary outcomes and secondary outcomes were evaluated. Results: Extremity volumes in Group 1 and Group 2 were reduced from preoperatively 4600±540 ml and 4740 ± 420 ml to postoperatively 4440±430 ml and 4660 ± 400 ml, respectively. There were no differences between two groups by means of time to return to work and complications. Extremity volumes and Visual Analogue Scale pain scores were detected statistically significant reduction at the end of 4 weeks in group 1. Conclusion: Additional use of compression stockings after isolated vena saphena parva stripping can provide significant reduction in extremity edema and visual analog scale pain score. On the other hand, developing complications and time to return to work in both groups seem similar, Amaç: Bu çalışmanın amacı, izole Vena SafenaParva stripingi sonrasında orta basınçlı elastikkompresyon çorabı kullanılmasının etkinliğiniaraştırmaktır.Gereç ve Yöntem: 2011 Ocak ile 2014 Marttarihleri arası izole Vena Safena Parva yetmezliğinedeniyle opere edilen 60 hasta (40 kadın, 20 erkek,yaş ortalaması; 39± 11, 35-58 yaş arası) burandomize kontrollü retrospektif çalışmaya dahiledildi. Ekstremitelere postoperatif 3 gün boyuncaelastik bandaj uygulandı. Hastalar ilaveten 4haftalık kompresyon çorabı giyenler (Grup 1; 18kadın, 12 erkek, yaş ortalaması 35±12,2, 23-47 yaşarası] ve giymeyenler (Grup 2; 22 kadın, 8 erkek,yaş ortalaması 38±10.8, 27-49 yaş arası.) olmaküzere iki gruba ayrıldı. Primer sonlanım vesekonder sonlanım sonuçları değerlendirildi.Bulgular: Çalışma ve kontrol grubunda bacakortalama hacimleri sırasıyla preoperatif 4600±540ve 4740 ± 420 ml iken postoperatif 4. hafta sonunda4440±430 ml ve 4660 ± 400 ml’e geriledi. Dörthaftalık takip döneminde işe dönüş,komplikasyonlar açısından fark gözlenmedi. Bacakhacimleri ve vizuel analog skala ağrı skorlarındagrup 1’de istatistiki olarak anlamlı derecede birazalma saptandı.Sonuç: İzole vena safena parva stripingi sonrasıilave elastik kompresyon çorabı giyilmesiekstremite ödemi ve postoperatif ağrı hissindeanlamlı derecede azalma sağlayabilir. Diğer taraftanvaris çorabı kullananlar ile kullanmayanlarkomplikasyon gelişimi ve işe dönüş zamanıaçısından benzer görünmektedir.Anahtar Kelimeler: Vena safena parva, striping,komplikasyon, skleroterapi

Мета роботи – покращити результати комплексного консерва- тивного лікування хворих літнього та старечого віку на трофічні виразки нижніх кінцівок на тлі хронічної венозної, серцево- судинної недостатності та цукрового діабету ІІ типу з викорис- танням ад'ювантної загальної та місцевої фармакотерапії в умо- вах амбулаторії загальної практики та сімейної медицини. Матеріал і методи. У статті представлено десятирічний досвід консервативного лікування 834 хворих на трофічні виразки нижніх кінцівок венозної та іншої етіології в умовах стаціонару сільської дільничної лікарні та лікарської амбулаторії загальної практики і сімейної медицини з використанням ад'ювантного загального ліку- вання на основі Орегонського протоколу (1999), а також місцево- мазевих лікувальних пов’язок (Унна-Кефера) з дотриманням прин- ципу перебігу фаз ранового процесу і застосуванням лікувальної та пожиттєвої, щоденної еластичної компресії. Результати. При виразках діаметром від 2 до 5см (344) курс ліку- вання до повної епітелізації становив від 2 до 5 тижнів; а при трофічних виразках у діаметрі від 6 до 9 см (179) – 6-10 тижнів. У 31 хворого загоєння проходило під пов’язкою Унна-Кефера , а в 59 хворих при виразках діаметром більше 10 см терміни лікування становили 15-18 тижнів, з багаторазовим використанням пов’я- зок Унна-Кефера. У 44 (7 %) пролікованих хворих наступили реци- диви виразок через порушення режиму компресійної терапії. Висновки. Таким чином, застосування вищенаведеного лікування з дотриманням принципу лікування з врахуванням перебігу фаз рано- вого процесу та лікувальної і пожиттєвої, щоденної еластичної компресії, дає можливість у 93 % отримати стійкий лікувальний ефект., Цель работы – улучшить результаты комплексного консервативного лечения больных пожилого и старческого возраста с трофическими язвами нижних конечностей на фоне хронической венозной, сердечно-сосудистой недостаточности и сахарного диабета II типа с использованием адювантной общей и местной фармакотерапии в условиях амбулатории общей практики и семейной медицины. Материал и методы. В статье представлено десятилетний опыт консервативного лечения 834 больных с трофическими язвами нижних конечностей венозной и другой тиологии во врачебной амбулатории общей практики и семейной медицины, с дневным стационаром при использовании адювантного общего лечения на основе Орегонского протокола (1999), а в местной терапии – мазевых лечебных повязок, в т.ч. Унна-Кефера, с тщательным соблюдением принципа течения фаз раневого процесса, а также применения лечебной и пожизненной, ежедневной ластической компрессии. Результаты. При язвах диаметром от 2 до 5см (344) курс лечения до полной пителизации был от 2 до 6 недель; а при ТВ в диаметре от 6 до 9 см (179) составлял 6-10 недель. При том, у 31 из них заживление наступало под повязкой Унна-Кефера, а у 59 больных при язвах диаметром больше 10 см строки лечения были 15-18 недель, с многоразовым использованием повязок Унна-Кефера. В 44 (7 %) пролеченных больных наступили рецидивы язв из-за нарушения режима компрессионной терапии. Выводы. Таким образом, применение вышеуказанного лечения с соблюдением принципа течения фаз раневого процесса, а также лечебной, и пожизненной, ежедневной ластической компрессии, дат возможность в 93 % получить стойкий лечебный ффект., Objective. The aim of the work is to improve the results of complex conservative treatment of elderly and senile patients with trophic ulcers of the lower extremities on the background of chronic venous, cardiovascular insufficiency and type II diabetes mellitus with the use of adjuvant general and local pharmacotherapy in a general practice and family medicine outpatient setting. Materials and methods. The paper presents ten years of conservative treatment 834 patients (of them: in working age – 209, in the elderly and senile – 625), the trophic ulcers of the lower limbs and other venous etiology in a district hospitals (2007-2012) and in ambulatory general practice and family medicine (2013-2016), using a common adjuvant treatment Oregon protocol based (1999) and locally – ointment medical dressings, including Unna's boot, carefully principle of motion phases of wound healing, and the use of medical daily elastic compression. Result. Ulcers with a diameter of 2 to 5cm (344) treatment to complete epithelialization was between 2 to 5 weeks; and ulcers in diameter from 6 to 9 cm (179), he was 6-10 weeks. Thus, in 31 patients healing took place under the bandage Unna's boot and in 59 patients with ulcers with a diameter of 10 cm treatment periods were 15-18 weeks, with repeated use of Unna's boot. In 44 (7 %) treated patients with recurrent ulcers occurring due to violation of compression therapy. Conclusion. Thus, the use of above mentioned treatment, taking into account current phases of wound healing, and medical daily elastic compression makes it possible to get a 93 % sustained therapeutic effect.

This open registry aimed to evaluate the clinical evolution of postpartum varicose veins (VVs), in healthy women after the second pregnancy, how these veins regain shape and competence, and possible treatments. The registry included two groups of women: (1) those who used elastic compression stockings, and (2) who used an oral venotonic agent (Pycnogenol, 100 mg/d). A total of 12 evaluation targets were established. Minor symptoms were scored in an analogue scale line. A visual analogue scale line evaluated the overall satisfaction relative to elastic compression or Pycnogenol. Overall 133 women completed the registry evaluation with at least 3 months of follow-up. The resulting two registry groups were comparable. At 3 and 6 months in the Pycnogenol group the number of veins and incompetent sites were lower. At 6 months there were 13.3% of patients with edema in controls versus 3.2% in the Pycnogenol group. Spider veins decreased in Pycnogenol patients. Cramps and other minor symptoms were less common in the Pycnogenol group. In both groups there was a significant improvement at 6 months with better results in the Pycnogenol group. The need for treatment was limited with a decreased need for sclerotherapy, surgery, and conservative treatments in the Pycnogenol group. The overall satisfaction was higher among Pycnogenol patients, and compliance was optimal. Re-evaluation at 12 months indicated that the variations in VVs and spider vein clusters and the associated symptoms did not change. Most remodeling appeared to happen within 6 months after the pregnancy. It was concluded that the use of Pycnogenol improves signs/symptoms of postpartum VVs, and venous function and shape seem to return faster to prepartum, physiological pattern with its use.

BackgroundPost-thrombotic syndrome (PTS) is a long-term complication of deep vein thrombosis (DVT) that is characterised by chronic pain, swelling, and skin changes in the affected limb. One of every three people with DVT will develop post-thrombotic complications within five years. Several non-pharmaceutical measures are used for prevention of post-thrombotic syndrome during the acute phase of DVT. These include elevation of the legs and compression therapy. Clinicians and guidelines differ in their assessment of the utility of compression therapy for treatment of DVT. This is an update of a review first published in 2003.ObjectivesTo determine relative effectiveness and rate of complications when compression therapy is used in people with deep vein thrombosis (DVT) for prevention of post-thrombotic syndrome (PTS).Search methodsFor this update, the Cochrane Vascular Information Specialist (CIS) searched the Cochrane Vascular Specialised Register (20 March 2017) and CENTRAL (2017, Issue 2). The CIS also searched trial registries for details of ongoing or unpublished studies. SelectioncriteriaWe included randomised controlled trials (RCTs) and controlled clinical trials (CCTs) of compression therapy, such as bandaging and elastic stockings, in people with clinically confirmed DVT. The primary outcome was the occurrence of PTS.Data collection and analysis Two review authors (DK and EvL) identified and assessed titles and abstracts for relevance, and a third review author (DA) verified this assessment independently. Review authors imposed no restrictions on date or language of publications. Three review authors (DA, DK, EvL) used data extraction sheets to independently extract study data. We resolved disagreements by discussion.Main resultsWe identified 10 RCTs with a total of 2361 participants that evaluated compression therapy. The overall methodological quality of these trials was low. We used only five studies in meta-analysis owing to differences in intervention types and lack of data. Three studies compared elastic compression stockings (pressure of 30 to 40 mmHg at the ankle) versus no intervention. Two studies compared elastic compression stockings (pressure 20 to 40 mmHg) versus placebo stockings. Overall, use of elastic compression stockings led to a clinically significant reduction in the incidence of PTS (risk ratio (RR) 0.62, 95% confidence interval (CI) 0.38 to 1.01; P = 0.05; 1393 participants; 5 studies; low-quality evidence); no reduction in the incidence of severe PTS (RR 0.78, 95% CI 0.53 to 1.15; P = 0.21; 1224 participants; 4 studies; low-quality evidence); and no clear difference in DVT recurrence (RR 0.94, 95% CI 0.69 to 1.28; 1212 participants; 4 studies; P = 0.69; low-quality evidence). We did not pool data on the incidence of pulmonary embolism because this information was poorly reported, but we observed no differences between groups included in individual studies (low-quality evidence).Two studies evaluated effects of compression in the acute phase versus no compression treatment and found no differences in the incidence of PTS (RR 0.76, 95% CI 0.49 to 1.16; P = 0.2; 101 participants). One study reported that thigh-length stockings did not provide better protection against development of PTS than knee-length stockings (RR 0.92, 95% CI 0.66 to 1.28; P = 0.6; 267 participants). Another trial reported that wearing compression stockings for two years seemed to be superior to wearing them for one year in terms of PTS incidence.Two of the 10 included studies described patient satisfaction and quality of life (moderate-quality evidence), using different measurement systems. The first study showed significant improvement in well-being and DVT-related quality of life with compression treatment (P Authors'conclusionsLow-quality evidence suggests that elastic compression stockings may reduce the occurrence of PTS after DVT. We downgraded the quality of evidence owing to considerable heterogeneity between studies and lack of or unclear risk of blinding due to clinical assessment scores. No serious adverse effects occurred in these studies. Large randomised controlled trials are needed to confirm these findings because of current lack of high-quality evidence and considerable heterogeneity.

Background Post-thrombotic syndrome (PTS) is a long-term complication of deep vein thrombosis (DVT) that is characterised by chronic pain, swelling, and skin changes in the affected limb. One of every three people with DVT will develop post-thrombotic complications within five years. Several non-pharmaceutical measures are used for prevention of post-thrombotic syndrome during the acute phase of DVT. These include elevation of the legs and compression therapy. Clinicians and guidelines differ in their assessment of the utility of compression therapy for treatment of DVT. This is an update of a review first published in 2003. Objectives To determine relative effectiveness and rate of complications when compression therapy is used in people with deep vein thrombosis (DVT) for prevention of post-thrombotic syndrome (PTS). Search methods For this update, the Cochrane Vascular Information Specialist (CIS) searched the Cochrane Vascular Specialised Register (20 March 2017) and CENTRAL (2017, Issue 2). The CIS also searched trial registries for details of ongoing or unpublished studies. Selection criteria We included randomised controlled trials (RCTs) and controlled clinical trials (CCTs) of compression therapy, such as bandaging and elastic stockings, in people with clinically confirmed DVT. The primary outcome was the occurrence of PTS. Data collection and analysis Two review authors (DK and EvL) identified and assessed titles and abstracts for relevance, and a third review author (DA) verified this assessment independently. Review authors imposed no restrictions on date or language of publications. Three review authors (DA, DK, EvL) used data extraction sheets to independently extract study data. We resolved disagreements by discussion. Main results We identified 10 RCTs with a total of 2361 participants that evaluated compression therapy. The overall methodological quality of these trials was low. We used only five studies in meta-analysis owing to differences in intervention types and lack of data. Three studies compared elastic compression stockings (pressure of 30 to 40 mmHg at the ankle) versus no intervention. Two studies compared elastic compression stockings (pressure 20 to 40 mmHg) versus placebo stockings. Overall, use of elastic compression stockings led to a clinically significant reduction in the incidence of PTS (risk ratio (RR) 0.62, 95% confidence interval (CI) 0.38 to 1.01; P = 0.05; 1393 participants; 5 studies; low-quality evidence); no reduction in the incidence of severe PTS (RR 0.78, 95% CI 0.53 to 1.15; P = 0.21; 1224 participants; 4 studies; low-quality evidence); and no clear difference in DVT recurrence (RR 0.94, 95% CI 0.69 to 1.28; 1212 participants; 4 studies; P = 0.69; low-quality evidence). We did not pool data on the incidence of pulmonary embolism because this information was poorly reported, but we observed no differences between groups included in individual studies (low-quality evidence). Two studies evaluated effects of compression in the acute phase versus no compression treatment and found no differences in the incidence of PTS (RR 0.76, 95% CI 0.49 to 1.16; P = 0.2; 101 participants). One study reported that thigh-length stockings did not provide better protection against development of PTS than knee-length stockings (RR 0.92, 95% CI 0.66 to 1.28; P = 0.6; 267 participants). Another trial reported that wearing compression stockings for two years seemed to be superior to wearing them for one year in terms of PTS incidence. Two of the 10 included studies described patient satisfaction and quality of life (moderate-quality evidence), using different measurement systems. The first study showed significant improvement in well-being and DVT-related quality of life with compression treatment (P < 0.05) compared with bed rest, and the second study showed no differences in quality of life scores between compression and placebo groups. Four studies poorly reported side effects (low-quality evidence) that included itching, erythema, and other forms of allergic reaction and described no serious adverse events. Compliance with wearing of compression stockings was generally high but varied across studies. Authors' conclusions Low-quality evidence suggests that elastic compression stockings may reduce the occurrence of PTS after DVT. We downgraded the quality of evidence owing to considerable heterogeneity between studies and lack of or unclear risk of blinding due to clinical assessment scores. No serious adverse effects occurred in these studies. Large randomised controlled trials are needed to confirm these findings because of current lack of high-quality evidence and considerable heterogeneity.

This chapter presents a quick and efficient approach to perform patient-specific Finite-Element (FE) predictions of the human calf response under elastic compression. The reconstruction of patient-specific material properties of soft tissues is based on two methodologies described extensively in two previous papers [1, 2]. After a detailed description of the implementation of this model, results obtained on four volunteers are presented. The deformed geometry predicted by the FE model is in very good agreement with the MRI scan of the same leg under elastic compression. Eventually , it is shown that elastic compression always induces a partial vein closure but the magnitude of vein closure depends strongly on the position of the vein, on the shape of the leg and on the material properties of surrounding soft tissues.

The scope of this study was to determine the effects of elastic compression sleeves on the biodynamic response of the hand-arm system by means of determination of vibration transmission. Three female and five male subjects were exposed to six different vibration treatments. The treatments had fixed amplitudes (0.45 mm) and grip strengths (60% of maximum gripping strength) but differed in frequencies (10 Hz, 25 Hz, 40 Hz) and arm compression conditions (sleeve with compression class 2 (3.1–4.3 KPa), no compression sleeve). The vibration transmissibility between both compression conditions was not significantly different.

Continuing treatment for two years looks beneficial for those who can Until recently, the effectiveness of elastic compression stockings for the prevention of post-thrombotic syndrome following deep venous thrombosis (DVT) was considered irrefutable. Compression stockings had been embedded in daily practice and in guidelines,1 2 at least in Europe, since two randomised clinical trials showed that compression reduced the incidence of post-thrombotic syndrome by more than 20%.1 2 The results of the SOX trial, published in 2014, challenged this dogma, suggesting that elastic compression did not prevent post-thrombotic syndrome.3 Although the trial was hampered by a lack of adherence to treatment, treating clinicians readily accepted the negative outcome. Since then, guidelines have been updated and compression stockings devalued and even discouraged.4 In a linked paper (doi:10.1136/bmj.i2691), Mol and colleagues report the results of the OCTAVIA trial, a non-inferiority …

Background: The encouragement of early ambulation with compression rather than bed-rest becomes a matter of controversy. Aim: To evaluate the benefits of compression and walking exercises in comparison with bed rest in the acute stage of distal deep venous thrombosis. Methods: Twenty-eight patients with distal DVT that were randomized into 2 groups. The first group: 14 patients received low-molecular-weight heparin (LMWH) associated with bed rest & leg elevation for 7-10 days. The second group: 14 patients received LMWH and were allowed to be ambulant after 1-2 days with elastic compression stocks. Patients • assessment was essentially concerning with the reduction of leg pain & swelling and also checking out the propagation of thrombosis and/or development of pulmonary embolism. Results: Leg pain was reduced or abolished in 12/14 patients in the ambulant group compared to 10/14 patients in the bed-rest group. Also; the reduction of limb swelling in the ambulant group was better than that of the bed-rest one.Furthermore; propagation of thrombus was more in the bed-rest group (2/14) compared to the ambulant one (1/14). Conclusion: Patients with acute distal DVT treated with LMWH should be encouraged to walk with medical compression stockings.

International audience; Elastic compression is recommended in prophylaxis and the treatment of venous disorder of the human leg. However, the mechanisms of compression are not completely understood and the response of internal tissues to the external pressure is partially unknown. To address this later issue, a 3D FE model of a human leg is developed. The geometry is derived from 3D CT scans. The FE model is made up of soft tissues and rigid bones. An inverse method is applied to identify the properties of soft tissues which are modelled as hyperelastic, near-incompressible, homogeneous and isotropic materials. The principle is to calibrate the constitutive properties using CT scans carried out with and without the presence of a compression sock. The deformed geometry computed by the calibrated FE model is in agreement with the geometry deduced from the CT scans. The model also provides the internal pressure distribution, which may lead to medical exploitation in the future.

Elastic compression of the leg is a widely used treatment in case of pathologies related to venous insufficiency. Its benefits are not to be proven, but still, for some patients, the therapeutic goal is not reached. One goal of this treatment is to reduce transmural pressure applied to veins in order to restore or increase blood return to the heart by the transmission of the external pressure through soft tissues. This is a complex mechanism that can be predicted by patient-specific finite element models. To be patient-specific, these models must take into account the geometry and the distribution of mechanical properties of each subject.In this study, two methodologies are developed to identify the mechanical properties of soft tissues. First, the elastic modulus distribution inside the superficial soft tissues is measured by shear wave ultrasound elastography. Second, the mechanical properties of deep soft tissues are identified through an inverse method combining the data acquired from an experimental localized compression of the leg to a bi-dimensional finite element model.These two methodologies allow to evaluate the mechanical properties heterogeneity from the skin to the fascia cruris and to characterize the non-linear behaviour of deep soft tissues. Finally, the results from both methodologies are brought together to generate a biomechanical model of the leg under elastic compression to predict pressure distribution inside soft tissues for four healthy subjects., La compression élastique de la jambe est le traitement de référence des pathologies liées à l’insuffisance veineuse. Bien que l’efficacité ne soit plus à prouver, les objectifs thérapeutiques restent non atteints pour certains patients. Un objectif de la compression élastique est la réduction de la pression pariétale des veines afin de rétablir ou d’augmenter le retour du sang vers le cœur par une transmission de pression au travers des tissus mous. Ce mécanisme est complexe et peut être prédit par des modèles éléments finis personnalisés. Pour être personnalisés, ces modèles doivent prendre en compte la géométrie et la carte des propriétés mécaniques du sujet.Dans cette étude, on développe deux méthodologies permettant d’identifier les propriétés mécaniques des tissus mous. Dans un premier temps, on mesure par élastographie ultrasonore par onde de cisaillement la distribution du module élastique au sein des tissus mous superficiels. Dans un deuxième temps, on identifie par une méthode inverse les propriétés mécaniques des tissus mous profonds. Cette méthode associe l’acquisition de données d’un essai expérimental de compression localisée de la jambe à un modèle éléments finis bidimensionnel. Ces deux méthodologies nous permettent d’évaluer l’hétérogénéité des propriétés mécaniques de la peau au fascia cruris et de caractériser le comportement non-linéaire des tissus mous profonds. Enfin, les résultats de ces deux méthodologies sont couplés afin de générer un modèle biomécanique de la jambe sous compression élastique pour prédire la distribution de pression au sein des tissus mous pour quatre sujets sains.

Varela-Sanz, A, Espana, J, Carr, N, Boullosa, DA, and Esteve-Lanao, J. Effects of gradual-elastic compression stock- ings on running economy, kinematics and performance in runners. J Strength Cond Res 25(10): 2902-2910, 2011—We investigated the effect of gradual-elastic compression stock- ings (GCSs) on running economy (RE), kinematics, and performance in endurance runners. Sixteen endurance trained athletes (age: 34.73 6 6.27 years; _ VO2max: 62.83 6 9.03 mlkg 21 min 21 ; 38 minutes in 10 km; 1 hour 24 minutes in half marathon) performed in random order 4 bouts of 6 minutes at a recent half-marathon pace on a treadmill to evaluate RE with or without GCSs. Subsequently, 12 athletes were divided into 2 equal groups matched by their _ VO2max, and they performed a time limit test (Tlim) on a treadmill at 105% of a recent 10-km pace with or without GCSs for evaluation of physiological responses and running kinematics. There were no significant differences in the RE test in all of the variables analyzed for the conditions, but a moderate reproducibility for some physiolog- ical responses was detected in the condition with GCSs. In the Tlim, the group that wore GCSs reached a lower % of maximum heart rate (HRmax) compared with the control group (96.00 6 2.94 vs. 99.83 6 0.40) (p = 0.01). Kinematics did not differ between conditions during the Tlim (p . 0.05). There were improvement trends for time to fatigue (337 vs. 387 seconds; d = 0.32) and a lower _ VO2peak (53 vs. 62 mlkg 21 min 21 ; d = 1.19) that were detected with GCSs during the Tlim. These results indicate that GCSs reduce the % of HRmax reached during a test at competition pace. The lower reproducibility of the condition with GCSs perhaps suggests that athletes may possibly need an accommodation period for systematically experiencing the benefits of this garment, but this hypothesis should be further investigated.