The effect of compression ulcer stockings on the capillary filtration rate and the formation of edema

Summary

Increased ambulatory venous pressure is the key feature of chronic venous insufficiency, and causes capillary leakage and venous edema. This capillary leakage can be measured with plethysmography and is called the capillary filtration rate (CFR).

Reduction of the CFR leads to less edema formation and improves the healing of venous ulcers.

Aim: To show that the use of compression ulcer stockings reduces the CFR.

Methods: The capillary filtration rate of both legs of 17 patients, 6 with chronic venous insufficiency and 11 healthy subjects was measured with both (day and night) stockings, only the night stocking and without stockings.

Results: The reduction of the CFR was significant (p <0.0001) for the total population in the group wearing 2 stockings versus 1 stocking (CFR=0.019 vs. 0.084 ml/100 ml/min), 1 stocking versus no stocking (CFR=0.149 vs. 0.084 ml/100 ml/min) and 2 stockings versus no stockings (CFR=0.019 vs. 0.149 ml/100 ml/ min).

Conclusion: Compression ulcer stockings are highly effective in reducing CFR and thus reducing edema formation, which leads to improved healing of venous ulcers.

Zusammenfassung

Das zentrale Merkmal der chronischen venösen Insuffizienz ist ein erhöhter ambulanter Venendruck, welcher kapillare Leckagen und venöse Ödeme verursacht. Diese kapillare Leckage kann mit Plethysmographie gemessen werden: die kapillare Filtrationsrate (CFR).

Reduktion der CFR führt zu weniger Ödembil-dung und verbessert die Heilung von venösen Ulzera.

Ziel: Es sollte gezeigt werden, dass der Einsatz von Kompressionsstrümpfen die CFR reduziert.

Methode: Die kapillare Filtrationsrate beider Beine von 17 Patienten, 6 mit chronisch venöser Insuffizienz und 11 gesunden Probanden wurde gemessen. Die Patienten unterschie-den sich in drei Kategorien: Patienten mit zwei Kompressionsstrümpfen (Tag und Nacht), sol-che mit nur einem Nacht-Kompressionsstrumpf und Patienten ohne Kompressionsstrümpfe.

Ergebnis: Die Reduktion der CFR war signifikant (p <0,0001) für die Zweistrumpfkategorie im Vergleich zur Einstrumpfkategorie (CFR=0,019 zu 0,084 ml/100 ml/min), die Einstrumpfkategorie im Vergleich zur Kategorie ohne Kompressionsstrümpfe (CFR=0,149 zu 0,084 ml/100 ml/min) und in der 2-Kompressionsstrumpfkategorie im Vergleich zur Kategorie ohne Kompressionsstrümpfe (CFR=0,019 zu 0,149 ml/100 ml/min).

Fazit: Kompressionsstrümpfe sind sehr wirksam zur Reduktion der CFR, wodurch Ödembildung vermindert wird. Das führt zu einer besseren Heilung von venösen Ulzera.

Keywords

Capillary filtration - compression stockings - ulcer

Schlüsselwörter

Kapillare Filtration - Kompressionsstrümpfe - Ulzer

• References

• 1 Browse NL, Burnand KG. The cause of venous ulceration. Lancet 1982; 2 08292 243-245.
• 2 Junger M, Hahn U, Bort S, Klyscz T, Hahn M, Rassner G. [Significance of cutaneous microangio pathy for the pathogenesis of dermatitis in venous congestion due to chronic venous insufficiency]. Wiener medizinische Wochenschrift 1994; 144 010–11 206-210.
• 3 Leu HJ. [The current concept of the pathogenesis of trophic skin lesions in chronic venous insufficiency from the morphologic viewpoint]. Wiener medizinische Wochenschrift 1994; 144 010–11 199-200.
• 4 Eklof B, Rutherford RB, Bergan JJ, Carpentier PH, Gloviczki P, Kistner RL. et al. Revision of the CEAP classification for chronic venous disorders: consensus statement. J Vasc Surg 2004; 40 (06) 1248-1252.
• 5 Nicolaides AN. Investigation of chronic venous insufficiency: A consensus statement (France, March 5–9, 1997). Circulation 2000; 102 (020) E126-163.
• 6 Gamble J, Gartside IB, Christ F. A reassessment of mercury in silastic strain gauge plethysmography for microvascular permeability assessment in man. The Journal of Physiology 1993; 464: 407-422.
• 7 van Geest AJ, Veraart JCJM, Kitslaar PJEHM, Neumann HAM. Capillary filtration rate, before and after stripping of the greater saphenous vein, measured with air-plethysmography. Phlebology 1998; 13: 50-52.
• 8 Mostbeck A. [Methodological aspects of the determination of the capillary filtrate in the extremities. Simultaneous measurement of leg and regional blood volume by plethysmography and Tc-99m-labeled erythrocytes]. VASA 1986; 15 (03) 233-240.
• 9 van Geest AJ, Veraart JCJM, Nelemans P, Neumann HAM. The effect of medical elastic compression stockings with different slope values on edema. Measurements underneath three different types of stockings. Dermatol Surg 2000; 26 (03) 244-247.
• 10 Stacey MC, Vandongen Y, Trengove N, Ho skin S, Thompson P, Pearce C. The effectiveness of compression in healing of chronic venous leg ulcers. Phlebology 1995; Suppl. I 929-931.
• 11 Mayberry JC, Moneta GL, Taylor Jr. LM, Porter JM. Fifteen-year results of ambulatory compression therapy for chronic venous ulcers. Surgery 1991; 109 (05) 575-581.
• 12 Nelson EA, Bell-Syer SEM, Cullum NA. Compression for preventing recurrence of venous ulcers. Cochrane database of systematic reviews (Online) 2000; 4: CD002303
• 13 Erickson CA, Lanza DJ, Karp DL, Edwards JW, Seabrook GR, Cambria RA. et al. Healing of venous ulcers in an ambulatory care program: the roles of chronic venous insufficiency and patient compliance. J Vasc Surg 1995; 22 (05) 629-636.
• 14 van Geest AJ, Veraart JCJM, Nelemans P, Neumann HAM. The effect of medical elastic compression stockings with different slope values on edema. Measurements underneath three different types of stockings. Dermatol Surg 2000; 26 (03) 244-247.
• 15 Partsch H, Horakova MA. [Compression stockings in treatment of lower leg venous ulcer]. Wiener medizinische Wochenschrift 1994; 144 010–11 242-249.
• 16 Blair SD, Wright DD, Backhouse CM, Riddle E, McCollum CN. Sustained compression and healing of chronic venous ulcers. BMJ 1988; 297 06657 1159-1161.
• 17 Veraart JCJM, Neumann HAM. Interface pressure underneath elastic and non-elastic bandages. Phlebology 1996; Suppl. I 2-5.
• 18 Veraart JCJM, Neumann HAM. Effects of medical elastic compression stockings on interface pressure and edema prevention. Dermatol Surg 1996; 22 (010) 867-871.
• 19 Callam MJ, Ruckley CV, Dale JJ, Harper DR. Hazards of compression treatment of the leg: an estimate from Scottish surgeons. British medical journal 1987; 295 06610 1382
• 20 Ibegbuna V, Delis K, Nicolaides AN. Effect of lightweight compression stockings on venous haemodynamics. Int Angiol 1997; 16 (03) 185-188.
• 21 Amsler F, Willenberg T, Blattler W. In search of optimal compression therapy for venous leg ulcers: a meta-analysis of studies comparing diverse [corrected] bandages with specifically designed stockings. J Vasc Surg 2009; 50 (03) 668-674.
• 22 Junger M, Wollina U, Kohnen R, Rabe E. Efficacy and tolerability of an ulcer compression stocking for therapy of chronic venous ulcer compared with a below-knee compression bandage: results from a prospective, randomized, multicentre trial. Current medical research and opinion 2004; 20 (010) 1613-1623.