Wearing stockings to provide compression for the treatment of varicose veins

Evidence from randomised controlled trials is not sufficient to determine if compression stockings as the only and initial treatment are effective in managing and treating varicose veins in the early stages. Varicose veins are widened veins that twist and turn and are visible under the skin of the leg. They generally do not cause medical problems although many sufferers seek medical advice. Symptoms that may occur include pain, ankle swelling, tired legs, restless legs, night cramps, heaviness, itching and distress from their cosmetic appearance. Complications such as oedema, pigmentation, inflammation and ulceration can also develop. Compression stockings are often the first line of treatment and come in a variety of lengths, knee length to full tights, and apply different pressures to support the flow of blood in the veins.

Seven studies involving 356 participants with varicose veins and who had not experienced venous ulceration were included in this review. One study assessed compression hosiery versus no compression hosiery. The other six compared different types or pressures of stockings, ranging from 10 to 50 mmHg. The methodological quality of the included trials was unclear and not all studies assessed the same outcomes. One study included only pregnant women whilst other studies included participants who were on surgical waiting lists, that is, people who had sought medical intervention for their varicose veins.

The participants' subjective symptoms, and foot swelling and blood flow (physiological measures) improved in all of the studies that assessed these outcomes when stockings were worn, but these assessments were not made by comparing one randomised arm of the trial with a control arm in the same study. Conclusions from the individual studies regarding the optimum pressure provided by stockings were conflicting, although the results of one study suggested that lower pressured stockings (20 mmHg) may be as effective as higher pressured stockings (30 to 40 mmHg) for relieving symptoms. Conclusions regarding the optimum length of the stockings were inconclusive. No severe or long lasting side effects were noted.

Authors' conclusions: 

There is insufficient, high quality evidence to determine whether or not compression stockings are effective as the sole and initial treatment of varicose veins in people without healed or active venous ulceration, or whether any type of stocking is superior to any other type. Future research should consist of a large RCT of participants with trunk varices either wearing or not wearing compression stockings to assess the efficacy of this intervention. If compression stockings are found to be beneficial, further studies assessing which length and pressure is the most efficacious could then take place.

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Background: 

Compression hosiery or stockings are often the first line of treatment for varicose veins in people without either healed or active venous ulceration. Evidence is required to determine whether the use of compression stockings can effectively manage and treat varicose veins in the early stages. This is an update of a review first published in 2011.

Objectives: 

To assess the effectiveness of compression stockings for the only and initial treatment of varicose veins in patients without healed or active venous ulceration.

Search strategy: 

For this update the Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched August 2013) and CENTRAL (2013, Issue 5).

Selection criteria: 

Randomised controlled trials (RCTs) were included if they involved participants diagnosed with primary trunk varicose veins without healed or active venous ulceration (Clinical, Etiology, Anatomy, Pathophysiology (CEAP) classification C2 to C4). Included trials assessed compression stockings versus no treatment, compression versus placebo stockings, or compression stockings plus drug intervention versus drug intervention alone. Trials comparing different lengths and pressures of stockings were also included. Trials involving other types of treatment for varicose veins (either as a comparator to stockings or as an initial non-randomised treatment), including sclerotherapy and surgery, were excluded.

Data collection and analysis: 

Two authors assessed the trials for inclusion and quality (SS and LR). SS extracted the data, which were checked by LR. Attempts were made to contact trial authors where missing or unclear data were present.

Main results: 

Seven studies involving 356 participants with varicose veins without healed or active venous ulceration were included. Different levels of pressure were exerted by the stockings in the studies, ranging from 10 to 50 mmHg. One study assessed compression hosiery versus no compression hosiery. The other six compared different types or pressures of stockings. The methodological quality of all included trials was unclear, mainly because of inadequate reporting.

The symptoms subjectively improved with the wearing of stockings across trials that assessed this outcome, but these assessments were not made by comparing one randomised arm of a trial with a control arm and are therefore subject to bias.

Meta-analyses were not undertaken due to inadequate reporting and actual or suspected high levels of heterogeneity.

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