Guide to Compression Stockings

SIGVARIS
A GUIDE TO
COMPRESSION
THERAPY
for
Healthcare
Professionals
THE WORLDWIDE
Graduated Compression Experts
Why SIGVARIS ?
Our mission is to produce the best compression garments, which will
enhance our customers’ health and quality of life.
We have been developing graduated compression garments for more than 50 years,
and we continue to invest in medical research. Our garments are found in 50 countries, and
our company was established with the expert knowledge of physician Dr. Karl Sigg.
OUR PRODUCTS SPAN THREE UNIQUE CATEGORIES
M EDICA L
WE LL B E I NG
SPORT S
OUR FEATURES & BENEFITS
Q UA L I TY
C OM F ORT
Trusted
Improved Patient Compliance
Preventative
Effective
We exceed physician, patient and athlete expectations
with products that meet FDA standards.
We offer the best medicine for venous disorders.
FI T
SIGVARIS products feature double-covered inlay yarns,
making them easy to put on and take off.
Our garments improve energy levels and leg health.
I NNOVATI ON
Precision Ready-to-Wear
Our sizing reflects today’s population based on
human data measurement studies.
Tailored
Energizing
We improve circulation for achy-free legs.
Fashionable
We use the finest textiles to create fashion-forward styles.
We offer premium products designed for
all shapes and sizes, from petite to plus.
L IFE CHAN G I N G
We are improving leg health one pair of legs at a time!
THE WORLDWIDE GRADUATED COMPRESSION EXPERTS
The Circulatory System
The arterial system uses the power of the heart to drive oxygenrich blood throughout the body. One-way valves in the venous
system aid the flow of blood back to the lungs and heart (against
the pull of gravity) by opening and closing when the calf muscles
contract and relax (see illustration below). When the calf muscles
relax, the valves close to prevent blood from refluxing (reversing
flow) into the lower part of the vein. These valves are fragile and
can easily become damaged (see illustration below right).
Calf Muscles Contracting and Relaxing
Muscles in
relaxed state
Closed valve
prevents blood
from flowing
backwards
(reflux)
Contracted
muscles
squeezing
veins
Reflux can cause pressure to build within the vein, which
stretches the vein walls and weakens them. The valves may
become incompetent, which leads to a progression of lower
extremity disorders, including aching, heavy legs, varicose veins,
skin changes and even a venous leg ulcer.
Valve Open
Valve Closed
Blood flows toward the heart
Prevents blood from reverse flow
Competent vs. Incompetent Valves
1
2
3
Valve Open
Valve Closed
1.Valve
Open:
the
Blood flows toward
the heartBlood flows
Prevents toward
blood from reverse
flowheart.
Open valve
allows blood
to flow towards
the heart
When valves don’t close
They become incompetent. Reverse
blood flow causes “pooling” and
weakening of the vein wall.
2.Valve Closed: Prevents blood from reverse flow.
3.When Valves Don’t Close: They become incompetent. Reverse
blood flow causes “pooling” and weakening of the vein wall.
How Graduated Compression Works
When valves don’t close
They become incompetent. Reverse
blood flow causes “pooling” and
weakening of the vein wall.
SIGVARIS graduated compression garments work by acting as an external layer
of muscle, gently squeezing the stretched vein walls together and allowing
valves to function and restoring blood flow closer to a normal state. Having
pressure greatest at the ankle, decreasing as it goes up the leg, helps fight the
force of gravity and circulate blood back to the heart more effectively improving
overall circulation.
To be most effective, the compression garment should be put on at the start
of the day and removed before going to bed. Remember, venous circulation
problems can progressively worsen over time and can affect a patient’s quality
of life. Problems in the legs should be treated as early as possible to help reduce
the rate of progression.
Decreasing
Compression up
the Leg
Higher
Compression at
the Ankle
CEAP Classification
The CEAP Classification was introduced in 1994 in an attempt to maintain a system that would allow the differentiated classification
of venous diseases. In 2004, this classification system revised1 its position in the relevant literature and is used in particular within the
scope of scientific publications.
Every letter in the CEAP classification system stands for a venous disease component:
C = Clinical signs: (score of 0–6), a = asymptomatic, s = symptomatic
E = Etiology: etiological classification according to congenital, primary and secondary
A = Anatomy: affected segments of veins, superficial, deep, perforating veins
P = Pathophysiology: pathophysiological dysfunction, reflux, obstruction, reflux and obstruction
Clinical Classification
C0
• No visible or palpable signs of venous disease
C1
• Telangiectasies or reticular veins
C2
• Varicose veins; distinguished from reticular veins by a diameter of 3 mm or more
C3
• Edema
C4a • Pigmentation or eczema
C4b • Lipodermatosclerosis or atrophie blanche
C5
• Healed venous ulcer
C6
• Active venous ulcer
S
• Symptomatic, including ache, pain, tightness, skin irritation, heaviness and muscle cramps,
and other complaints attributable to venous dysfunction
A • Asymptomatic
Etiologic Classification
Ec
• Congenital
Ep • Primary
Es
• Secondary (postthrombotic)
En • No venous cause identified
Anatomic Classification
As
• Superficial veins
Ap • Perforator veins
Ad • Deep veins
An • No venous location identified
Pathophysiologic Classification
Pr • Reflux
Po • Obstruction
Pr, o • Reflux and obstruction
Pn • No venous pathophysiology identifiable
C1
Telangiectasias
or reticular veins
C2
Varicose
veins
C3
Edema &
corona
C4
Lipodermatosclerosis & eczema
C5
Ulcer
scar
1 Eklöf Bo. MD et al. 2004. “Revisions of the CEAP classifications for chronic venous disorders: Consensus Statement.” Journal for Vascular Surgery September 28
C6
Active
ulcer
What Level of Compression?
The therapeutic effect of graduated compression stockings is based on the compression level.
With the proper CEAP classification, the correct compression level at the ankle can be chosen.
For more severe symptoms, consult with a vascular specialist.
Compression Level at the Ankle
Symptoms / Indications
15–20mmHg
▪▪ Tired, achy legs
▪▪ Occupational or evening edema
▪▪ Leg discomfort from long hours of standing or sitting
▪▪ Prophylaxis of varicosities & swelling during pregnancy
▪▪ Prophylaxis for legs predisposed to risk
▪▪ Reduce swelling during travel
▪▪ Prophylaxis of DVT during travel
18–25mmHg
▪▪ Diabetics who experience edema (see Cautions below)
20–30mmHg
▪▪ Heavy, fatigued, aching legs
▪▪ Mild edema in lower extremities
▪▪ Mild varicosities with minimal edema
▪▪ Mild varicosities during pregnancy
▪▪ Minimal edema upper extremities
▪▪ Post-procedure of small veins
▪▪ Prevention or management of DVT
30–40mmHg
▪▪ Moderate varicosities with mild to moderate edema (also during pregnancy)
▪▪ Post-procedure of larger veins to maintain treatment success
▪▪ CEAP C3 (edema), C4 (skin changes without ulceration), C5 (skin changes with healed
ulceration), C6 (skin changes with active ulcerations)
▪▪ Management and treatment of DVT or Post-Thrombotic Syndrome
▪▪ Superficial phlebitis
▪▪ Lymphedema after decongestant therapy to maintain reduction
▪▪ Orthostatic / postural hypotension
▪▪ Post-fracture, post-traumatic edema
40mmHg or higher
▪▪ Irreversable lymphadema (lifelong comrpession)
▪▪ Severe Post-Thrombotic Syndrome
▪▪ Severe varicosities and/or edema
Note: Stockings with the indications of 30mmHg or higher should only
be prescribed by medical specialists
Contraindications
▪▪ Arterial insufficiency, intermittent claudication, ischemia
▪▪ Uncontrolled congestive heart failure
Cautions
▪▪ Skin sensitivities or allergies
▪▪ Advanced neuropathy indicating sensory loss in leg or foot
▪▪ Diabetes with advanced arterial compromise
▪▪ Confinement to bed or non-ambulatory use unless otherwise
prescribed by the physician
▪▪ Eczema, hyperdermatitis, dermasclerosis, dermatitis (following treatment)
No liability accepted for non-observance of contraindications and cautions.
Fronek HS, Bergan JJ, et al. The Fundamentals of Phlebology: Venous Disease for Clinicians. 2004. pg 151. Blaettner, et al. Leg Symptoms of Healthy People and Their Treatment with
Compression Hosiery. Phlebology 2008. Compression therapy of the extremities, Partsch, Rabe, Stemmer. ISBN: 2.85480.770.7.
Choosing the Appropriate Style
Style
Reasons to Wear It
Calf
Thigh
▪▪ In many cases of venous insufficiency, a calf stocking can provide clinical improvement
▪▪ Sufficient in pregnancy as prophylaxis or with thigh varices
▪▪ Varicosis in the area of the femur with insufficiency of the saphenous-femoral
junction (SFJ) / venous reflux / and or leg problems
▪▪ Deep vein thrombosis in the thigh area
▪▪ Superficial thrombophlebitis in the thigh
▪▪ Thigh varices in pregnancy
▪▪ After surgical varicose vein treatment in the thigh area
▪▪ Lipedema or lymphedema in the thigh area
Thigh with
Waist
Attachment
▪▪ As an alternative to Pantyhose for those patients who cannot/ do not want to wear
thigh stockings with grip tops
▪▪ For elderly patients, as they are easier to handle than pantyhose
▪▪ For men
Pantyhose
▪▪ For those patients who cannot / do not want to wear thigh stockings with grip tops
(e.g. soft connective tissue, poor fit of the grip top, abundant body hair)
▪▪ Patients with varicose veins in the groin area
Maternity
Pantyhose
▪▪ Pregnancy
▪▪ As an alternative to pantyhose for patients with larger waist circumference
* The design of maternity pantyhose avoids any compression pressure on the abdominal area
Closed Toe
▪▪ Needed for medical reasons where compression is required in the toe area, e.g. with
edema in the feet area
▪▪ For orthopedic reasons, with a pronounced hallux (the lower end of the open toe
stocking may put pressure on the hallux)
Open Toe
▪▪ Suitable for all patients, who do not need a closed toe stocking
▪▪ More comfortable to wear in warm temperatures
▪▪ Better suited for elderly patients, as it is easier to put on
▪▪ May cause constriction at the toe end of the stocking (as such not suited for hallux)
▪▪ Allows monitoring the discoloring of the toes
Frequently, the decision is influenced by the patient, with factors such as
habit, compliance, or footwear playing an important role.
SIGVARI S M E D ICA L
Energized
Sheers
that are...
Preventative
Best Medicine for Venous Disorders
Fashionable
Designed with Everyday Comfort
Trusted
by Physicians & Patients
She’s wearing
EVERSHEER Pantyhose
Compression Level
20–30mmHg
THE WORLDWIDE GRADUATED COMPRESSION EXPERTS
To find your local SIGVARIS dealer, please visit
sigvarisusa.com/find or call
1.800.322.7744 (US)
Writing a Prescription
Writing specific information provides guidance to the
certified fitter filling the prescription. Be sure to indicate
brand, strength, and style:
▪▪ Brand: Not all graduated compression is the same!
SIGVARIS guarantees compression the levels on all of its
products and incorporates the latest sizing data to best fit
our patients.
▪▪ Strength: Make sure to specify a mmHg number for the
level of compression, “20–30mmHg” instead of “light”,
“mild”, “strong”, etc. (see “What Levels of Compression?”
section for more information).
▪▪ Style: Specify which garment type: calf, thigh, panty,
maternity, etc. (see “Choosing the Appropriate Style”
section for more information).
POWERED
SOCKS
that are...
Preventative
Best Medicine for Venous Disorders
Trusted
by Physicians & Patients
Stylish
Designed with Everyday Comfort
Anti-Embolism vs.
Graduated Compression
Anti-embolism stockings (e.g. TEDS®) and graduated
compression stockings are NOT the same. Anti-embolism
stockings are for recumbent patients, whereas graduated
compression stockings are for ambulatory patients.
Daily Compliance
Is Crucial
When a patient has difficulty complying with a higher
strength, the use of a donning aid, layering two garments
(e.g. underliner and garment), or a lower strength may
be considered.
A properly measured, sized and fitted garment will enhance
the therapeutic results. Your SIGVARIS Certified Fitter is
trained to properly care for your patient.
SIGVARIS, INC.
1119 Highway 74 South
Peachtree City, GA 30269
USA
Tel 800–322-7744
sigvarisusa.com
SIGVARIS, CORP.
4535 Dobrin
Ville St-Laurent, Quebec, Canada
H4R 2L8
Tel 800–363-4999
sigvaris.ca
Patient Counseling Tips
If your patient is new to graduated compression garments, he
or she might need some direction. Here are some questions
to ask your patients.
▪▪ Do you have any fabric allergies?
▪▪ Have you previously worn compression? If so, at which
level of compression?
The SIGVARIS Certified Fitter will detail about wearing our
graduated compression product:
▪▪ Get heel in place first
▪▪ Don’t overstretch product or roll it down
▪▪ Smooth out any wrinkles
▪▪ On calf-length stockings, top band should be two
fingers’ width below right-angle bend of the knee
Please note: If your patient is experiencing pain while wearing
compression, have him or her remove it immediately.
Resource for More Information:
stemmerlibrary.com
SIGVARIS is a registered trademark of SIGVARIS AG, CH-9014 St.Gallen/Switzerland, in many countries worldwide.
© Copyright 2013 SIGVARIS, Inc.
Supima is a registered trademark of the Supima Association of America Corporation
LIT-DOCGUIDE REV. 09.13