Post on 04-Feb-2021
transcript
Stockings and Compression
Devices for Venous and
Lymphatic Disease
Thom Rooke
Krehbiel Professor of Vascular Medicine
Mayo Clinic
Disclosure
Thom Rooke, M.D., FACC
I have no financial relationship(s) to disclose.Osborn Medical – Royalty
Merck – Event Adjudication
Advanced Venous Therapy – Royalty
Why treat venous / lymph disease?
• Pain
• Edema
• Cosmesis
• Prevention
• Pain
• Edema
• Cosmesis
• Prevention
• mattress tester
• skinny jean model
Job may be
affected:
Why treat venous / lymph disease?
So what?
• Pain
• Edema
• Cosmesis
• Prevention
Why treat venous / lymph disease?
• Pain
• Edema
• Cosmesis
• Prevention
Problem: Cosmesis has a big
subjective component
Payors routinely cover for:
Burns / Mastectomy / Birth
Defects / Others
Why treat venous / lymph disease?
Carrot Top
Carrot Top
• Pain
• Edema
• Cosmesis
• Prevention
… Surprisingly, compression has
never been shown to prevent ulcer
formation in patients with primary
venous insufficiency. Post deep vein
thrombosis, compression has been
shown to prevent post-thrombotic
syndrome and ulcer formation …
Chronic Venous Insufficiency
By Dr. Ido Weinberg | Published: March 16, 2011
Why treat venous / lymph disease?
How to treat venous / lymph disease
Fix the
problem
Really Good !
Fix the
problem
How to treat venous / lymph disease
Not so Good !
Manage the
problem
How to treat venous / lymph disease
Elastic
Manage the
problem
How to treat venous / lymph disease
Non-Elastic
How
compression
works …
Instead, an
editorial
comment …
Stockings
Improve Don’t Improve
Continue Surgery
Vein Disease
Effectiveness
Availability
Cost
Acceptability
versus
Conventional WisdomCompression versus
InterventionFor treatment of Venous Disease
Effectiveness
Availability
Cost
Acceptability
J Vasc Surg. 1987 Jan;5(1):148-59.
Air-plethysmography and the effect of elastic
compression on venous hemodynamics of the leg.Christopoulos DG, Nicolaides AN, Szendro G, Irvine AT, Bull ML, Eastcott HH.
AbstractLeg volume changes during exercise have been measured in absolute units
(milliliters) by means of a new method of air-plethysmography … …
measurements were repeated with a graduated medium compression stocking
in limbs with SVI and graduated high compression stockings in limbs with
DVD. … The results indicate that this method of air-plethysmography is not
only of diagnostic value but offers a new and unique technique to assess and
study the hemodynamic effects of different forms of elastic compression.
The lower ambulatory venous pressure,
produced by the elastic compression, was the
result of a reduction in reflux and an
improvement in the calf muscle ejecting ability
during rhythmic exercise.
Factors affecting choice of therapy for
venous / lymphatic disease
Surgery = Effective
http://www.ncbi.nlm.nih.gov/pubmed?term=%22Christopoulos%20DG%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Nicolaides%20AN%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Szendro%20G%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Irvine%20AT%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Bull%20ML%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Eastcott%20HH%22%5BAuthor%5D
Effectiveness
Availability
Cost
Acceptability
…Stony Brook
Vein Center…
Factors affecting choice of therapy for
venous / lymphatic disease
Effectiveness
Availability
Cost
Acceptability
Factors affecting choice of therapy for
venous / lymphatic disease
Effectiveness
Availability
Cost
Acceptability
“Conservative”
isn’t cheap.
Just “cheaper.”
Factors affecting choice of therapy for
venous / lymphatic disease
Surgical
Therapies
Stockings
Effectiveness
Availability
Cost
Acceptability
• Hard to get on
– DJD, age
• Hot / Tight /
Uncomfortable
• Don’t “cure”
the problem Ugly
Factors affecting choice of therapy for
venous / lymphatic disease
Surgery – not so
invasive anymore
Trends in Patient Reported Outcomes of Conservative and Surgical Treatment of Primary Chronic Venous
Disease Contradict Current Practices
Lurie, Kistner
American Venous Forum -- San Diego, 2011
150 patients / C 2-4 / SQOR – V / Symptom Score and QOL
150
74% 26%
% Improved with stockings
80% opted to discontinue
stockings and have surgery
Chances of improving
with surgery are 21X
higher if there is
improvement with
stockings !!% Did Not Improve …
Conventional Wisdom
Stockings
Improve Don’t Improve
Continue Surgery
More Logical
Improve
Surgery
Don’t Improve
Compression
Even Better?
Surgery
Vein Disease Vein Disease
Vein Disease
ImproveDon’t
ImproveCompression
The End