Compression Stockings and Post-thrombotic Syndrome (PTS)
Leg swelling, venous eczema, skin discolouration with thickening, and leg ulcers, occur in about 20-50% of patients who develop deep vein thrombosis (DVT). This cluster of changes, which often occurs gradually over several years, is called post-thrombotic syndrome (PTS). The cause of PTS is failure of blood to return efficiently to the heart after a DVT has blocked or damaged the deep veins of the legs. These vein valves keep blood flowing towards the heart, even while standing. Compression stockings play an essential role in maintaining blood flow towards the heart, and subsequently reducing the risk of PTS.
PTS symptoms caused by swelling, such as aching and heaviness, reduce a patient’s quality of life. Everyday activities, like walking and standing, become difficult and painful. As bending is difficult, simple actions like getting dressed and other everyday tasks take longer. Patients may withdraw from their normal social and family activities and may show signs of lowered mood as their condition deteriorates and their self-confidence deteriorates. If their condition worsens, some patients might need extra help to cope with their everyday activities, like showering, dressing and preparing food. This places a greater burden on health services and the economy as patients also seek care in the public health system.
There is controversy as to whether compression stockings can prevent the venous eczema, pigmentation and ulceration that may occur several years after a DVT 1. Recent studies have shown that wearing compression stockings regularly after a DVT can help to prevent these skin problems developing, and improve an individual’s quality of life 2.
An ultrasound scan, performed by a technician called a sonographer, is the next step in confirming the diagnosis of DVT. This can also confirm blockage or failure of the deep vein valves, and subsequently determine firstly the risk of developing PTS, and secondly the usefulness of long term compression stockings. An ultrasound scan of the leg arteries is also often useful for compression stockings planning purposes. Ultrasound scans are available at REV Vascular Ultrasound.
Treatment of DVT in the early stage usually involves blood thinners, such as Warfarin and Rivaroxaban. In some large DVTs affecting the leg and pelvic veins together, a clot-dissolving treatment called thrombolysis can be effective. The purpose of blood thinners is prevention of more blood clots, and detachment with travel to the lungs. This is a serious and sometimes life-threatening condition called pulmonary embolism.
Properly fitted compression stockings reduce leg swelling caused by DVT, and other causes such as varicose veins and lymphoedema. Compression stockings aid circulation and increase by controlling the build-up of swelling during the day.
People who work in standing occupations, particularly those who are prone to leg swelling will gain significant benefit from wearing well-fitted stockings. Even people who do not have any problems with leg swelling will get benefit from the regular use of compression stockings, as they support legs throughout the day.
Where can I get compression stockings?
Vascular specialists recommend that a vascular nurse or other allied health professional measures and fits the compression stockings. The correct fit is important for the best results in terms of comfort and effectiveness. Once wearing them in everyday life, a patient may find a pair of rubber gloves useful to apply the stockings. Custom made rubber gloves, with grips on the palms and fingers are also available. This is especially helpful for patients with poor strength in their fingers. Other aids include fixture glue, which helps to keep the stockings up. Medical fixture glue is specially formulated for use on sensitive skin, especially the skin on the thigh area, as this is where the stockings are most likely to sag.
Stockings fitting appointments are available in any of our clinics. Compression stockings (to the knee) are available in our online shop.