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Background: Implementation of guidelines to prevent venous thromboembolism (VTE) is essential to help guide junior medical staff but adherence to such protocols is insufficient. This study aims to audit the use of VTE prophylaxis (Tinzaparin 3500 units and/or thromboembolic deterrent stockings (TED) in general surgical inpatients in a district hospital on a random day at the beginning (Group A) and at the end of the junior house officer's 6 monthly term (Group B)., Methods: Patients were analyzed within the subgroups elective and emergency admissions and assessed regarding the appropriate prescription of tinzaparin and TED-stockings. The presence of a significant time lag between patients arriving on the ward and VTE-prophylaxis being prescribed was documented., Results: Tinzaparin was appropriately prescribed or not prescribed if contraindicated in 86% of elective admissions in Group A (versus 91% in Group B) and in 58% of emergency admissions in Group A (versus 85% in Group B). The subcutaneous injection of tinzaparin was commenced on the day of admission in 67% in Group A and in 75% of patients in Group B. CONCLUSIONS. Despite the institution of local guidelines adherence to such recommendations appears to be sub-optimal even at the end of the junior house officer's 6 monthly term when one would expect a higher vigilance.

Purpose: We evaluated the effects of wearing 20 to 30 mm Hg gradient thigh-length stockings during daily activity on the lower leg venous system., Methods: Twenty-one healthy women volunteers, aged 39 +/- 12 years, were examined. One subject was clinical class 4, one was class 2, two were class 1, and the remainder were class 0. The diameter of the posterior tibial, peroneal, and greater saphenous veins were measured at midcalf by means of bilateral duplex ultrasound scanning; calf circumference was measured at the same level. In addition, the number and caliber of all detectable medial calf perforating veins were recorded. Each subject was examined on two separate days, one while wearing the gradient stockings and one not wearing them. Baseline measurements were made on each day before the subjects began their workday, with follow-up measurements made after approximately 4.5 hours of normal activity., Results: Calf circumference increased an average of 23.8 +/- 10.1 mm without stockings (P <.001) and decreased by 5.2 +/- 7.0 mm when wearing stockings (P =.003). The number of detected perforating veins increased without stockings by 1.8 +/- 2.0 at the follow-up examination (P =.002); with stockings, the change was 0.4 +/- 1.2 (P = NS)., Conclusion: Graded compression elastic stockings help preserve lower leg venous caliber and tone throughout the deep, superficial, and perforating venous systems during normal ambulatory activity, and this may, in part, explain their beneficial effects.

Chronic venous insufficiency (CVI) is a burden to many workers, especially to those with a standing profession. Preventive measures are seldom taken. A quasirandomized parallel group trial was performed in 114 male workers with CVI and a standing profession. For 3 months, class II compression stockings or rubber floor mats were used vs controls. Outcome measures were diurnal volume changes (leg swelling) and complaints of the lower legs. With the stockings, a significant decrease in complaints was found, as well as a significant decrease in leg swelling. Rubber mats were often not suitable for hygienic and safety reasons. The decrease in complaints in the group using rubber mats was less pronounced, and leg swelling did not differ from that of the control group. Compression stockings appeared to be superior to rubber mats with regard to applicability, diminishing subjective complaints, and decrease of diurnal leg swelling.

The superficial and deep venous network of patients with chronic venous insufficiency is constantly undergoing change requiring careful follow-up and adapted therapy. Prevention, whether physical or medical, is recommended at all stages of the disease. The veins must be protected from factors which worsen venous abnormalities and drugs improving venous return should be prescribed. It is essential to avoid further aggravation of chronic venous insufficiency. The treatment has two objectives. First, and most important, to diminish or alleviate global or local venous hyperpressure which can be attained by surgery or sclerotherapy of venous leaking, via the crosses or perforating veins, into the superficial network. Venous hyperpressure can also be reduced by re-establishing normal venous haemodynamics with conservative techniques included elastic support or surgical techniques including CHI-VA. Finally, the second objective is to diminish or alleviate inaesthetic varicose veins and telangiectases.

Venous function was investigated in 29 women during late pregnancy before and after short term treatment with graduated compression hosiery. A significant improvement of venous emptying was found, combined with a subjective decrease of leg problems such as swelling, tiredness and pain.

The effect of four DVT-prophylaxis-stockings was examined by computer-aided-video-plethysmography. An increase of venous outflow was observed under the influence of all elastic stockings; knee-stockings have a better effect than thigh-stockings.