Post Treatment Care

Why use compression?

 

 

Ideally the sclerosed vein walls will touch and the thrombus kept to a bare minimum, this is quite difficult to achieve especially in larger truncal veins.

 

 

More likely is a small sclero-thrombus that blocks the vein and is then re-organised. Compression will keep the thrombus to a minimum.

 

The main advantage of applying compression post sclerotherapy is that it helps minimises the size of the sclerothrombus and soft thrombus formation.

Keeping thrombus to a minimum lowers the likelihood of pigmentation and thrombophlebitis after treatment.

Compression will also increase the flow through the deep venous system and thus help blood flow in legs which have compromised venous return.

Compression is usually applied using an elastic stocking, limited stretch bandage or both.

Eccentric versus Concentric Compression

It is important to distinguish between concentric and eccentric compression

CONCENTRIC compression is a general compression of the limb and is achieved by applying a bandage or stocking around the limb.

ECCENTRIC compression is achieved by placing a pad between the bandage/stocking and treated vein. The pad provides an increased direct local compression over a treated vein segment in addition to the general compression provided by the bandage or stocking. Recommended for larger veins.

Guidelines for small veins?

Following microsclerotherapy of thread veins and venules concentric compression is sufficient. Although some practitioners will use a cotton wool ball or dental pad over a reticular vein to give local eccentric compression.

Generally a Class 2 stocking (23-32 mmHg at the ankle) is recommended although a Class 1 is advised if it improves patient compliance The stocking should be worn for at least 4 days continuously and for a further 10 days during the day.

Guidelines for large veins

ECCENTRIC compression is recommended for the immediate post injection period following the treatment of medium to large veins.

A compression pad and bandage are placed over the injected vein to provide eccentric compression. The pad is kept in place for 3-7 days to reduce thrombus formation.

Generally a Class 2 compression stocking is placed over the pad and bandage and is worn continuously for 1 week and then during the day for a further 2 weeks.

Users on slower connections can contact us for a copy of the Applying Bandages CD-ROM.

The evidence?

Weiss et al (1999) studied the effect of the duration of compression following micro-sclerotherapy using Class 1 stockings.

They concluded that wearing a Class 1 stocking for 2-3 weeks gave significantly better results than no compression, particularly if the results were followed up at 24 weeks.

Their conclusion was that compression significantly reduced the incidence of pigmentation and they advise patients to wear compression for 2-3 weeks.

They also noted that 7 days compression was better than no compression.