Advertisement

Advances in Therapy

, Volume 28, Issue 3, pp 227–237 | Cite as

Merino wool graduated compression stocking increases lower limb venous blood flow: A randomized controlled trial

  • Thomas Charles
  • Deborah Mackintosh
  • Bridget Healy
  • Kyle Perrin
  • Mark Weatherall
  • Richard Beasley
Original Research

Abstract

Introduction

Graduated compression stockings represent a nonpharmacological approach to reduce the risk of deep vein thrombosis (DVT) and pulmonary embolism (PE) due to prolonged immobility through reducing lower limb venous stasis. A novel merino wool, double-layer, below-knee graduated compression stocking has been developed to reduce the risk of air travel-related DVT and PE.

Methods

Twenty healthy adult participants were randomized to wear the novel graduated compression stocking on either the left or right leg. Doppler ultrasound measurements of popliteal venous blood flow were made on both legs over a 120-minute period. The primary outcome was peak systolic velocity in the popliteal vein at 120 minutes. Secondary outcomes included mean flow velocity, total volume flow, vein cross-sectional area, and change in ankle and calf measurements.

Results

The popliteal vein peak systolic velocity was 0.35 cm/s (95% confidence intervals [CI], 0.22 to 0.49, P<0.001) higher with stocking use at 120 minutes, a difference of 24%. Mean flow velocity and total volume flow were also significantly higher with stocking use. Ankle and calf circumference were decreased with stocking use, with an overall difference of −6.3 mm (95% CI, −11.3 to −1.2, P=0.021) and −7.9 mm (95% CI, −13.3 to −2.4, P=0.011), respectively.

Conclusion

The novel merino wool double-layer, below-knee graduated compression stocking increases lower limb venous blood flow during prolonged seated immobility. Its use is likely to reduce the risk of DVT and PE in situations of prolonged seated immobility, such as long-distance air travel. The reduction in lower limb swelling associated with their use suggests that the stockings are likely to have utility in the treatment of chronic venous insufficiency and lymphedema.

Keywords

blood flow compression stockings Doppler ultrasound popliteal vein venous thromboembolism 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Aldington S, Pritchard A, Perrin K, James K, Wijesinghe M, Beasley R. Prolonged seated immobility at work is a common risk factor for venous thromboembolism leading to hospital admission. Int Med J. 2008;38:133–135.CrossRefGoogle Scholar
  2. 2.
    Ferrari E, Chevallier T, Chapelier A, Baudouy M. Travel as a risk factor for venous thromboembolic disease: a case-control study. Chest. 1999;115:440–444.PubMedCrossRefGoogle Scholar
  3. 3.
    West J, Perrin K, Aldington S, Weatherall M, Beasley R. A case-control study of seated immobility at work as a risk factor for venous thromboembolism. J R Soc Med. 2008;101:237–243.PubMedCrossRefGoogle Scholar
  4. 4.
    Healy B, Levin E, Perrin K, Weatherall M, Beasley R. Prolonged work- and computer-related seated immobility and risk of venous thromboembolism. J R Soc Med. 2010;103:447–454.PubMedCrossRefGoogle Scholar
  5. 5.
    Hughes R, Hopkins RJ, Hill S, et al. Frequency of venous thromboembolism in low to moderate risk long distance air travellers: the New Zealand Air Traveller’s Thrombosis (NZATT) Study. Lancet. 2003;362:2039–2044.PubMedCrossRefGoogle Scholar
  6. 6.
    Paganin F, Bourdé A, Yvin J-L, et al. Venous thromboembolism in passengers following a 12-h flight: a case-control study. Aviat Space Environ Med. 2003;74:1277–1280.PubMedGoogle Scholar
  7. 7.
    ten Wolde M, Kraaijenhagen RA, Schiereck J, et al. Travel and the risk of symptomatic venous thromboembolism. Thromb Haemost. 2003;89:499–505.PubMedGoogle Scholar
  8. 8.
    Schwarz T, Siegert G, Oettler W, et al. Venous thrombosis after long-haul flights. Arch Intern Med. 2003;163:2759–2764.PubMedCrossRefGoogle Scholar
  9. 9.
    Scurr JH, Machin SJ, Bailey-King S, Mackie IJ, McDonald S, Smith PD. Frequency and prevention of symptomless deep-vein thrombosis in long-haul flights: a randomised trial. Lancet. 2001;357:1485–1489.PubMedCrossRefGoogle Scholar
  10. 10.
    Belcaro G, Geroulakos G, Nicolaides AN, Myers KA, Winford M. Venous thromboembolism from air travel: the LONFLIT study. Angiology. 2001;52:369–374.PubMedCrossRefGoogle Scholar
  11. 11.
    Cesarone MR, Belcaro G, Nicolaides AN, et al. Venous thrombosis from air travel: the LONFLIT3 study — prevention with aspirin vs low molecular weight heparin (LMWH) in high-risk subjects: a randomized trial. Angiology. 2002;53:1–6.CrossRefGoogle Scholar
  12. 12.
    Mendis S, Yack D, Alwan A. Air travel and venous thromboembolism. Bull World Health Organ. 2002;80:403–406.PubMedGoogle Scholar
  13. 13.
    Beasley R, Raymond N, Hill S, Nowitz M, Hughes R. Thrombosis: the 21st century variant of thrombosis associated with immobility. Eur Respir J. 2003;21:374–376.PubMedCrossRefGoogle Scholar
  14. 14.
    Beasley R, Heuser P, Raymond N. SIT (seated immobility thromboembolism) syndrome: a 21st century lifestyle hazard. NZ Med J. 2005;118:U1376.Google Scholar
  15. 15.
    Ng SM, Khurana RM, Yeang HW, Hughes UM, Manning DJ. Is prolonged use of computer games a risk factor for deep venous thrombosis in children? Clin Med. 2003;3:593–594.PubMedGoogle Scholar
  16. 16.
    Koullias GJ, Elefteriades JA, Wu I, Jovin I, Jadbabaie F, McNamara R. Massive paradoxical embolism: caught in the act. Circulation. 2004;109:3056–3057.PubMedCrossRefGoogle Scholar
  17. 17.
    Sigel B, Edelstein AL, Savitch L, Hasty JH, Felix WR Jr. Type of compression for reducing venous stasis: a study of lower extremities during inactive recumbency. Arch Surg. 1975;110:171–175.PubMedGoogle Scholar
  18. 18.
    Liu R, Lao TT, Kwok YL, Li Y, Ying MT. Effects of graduated compression stockings with different pressure profiles on lower-limb venous structures and haemodynamics. Adv Ther. 2008;25:465–478.PubMedCrossRefGoogle Scholar
  19. 19.
    Byrne B. Deep vein thrombosis prophylaxis: the effectiveness and implications of using below-knee or thigh-length graduated compression stockings. Heart Lung. 2001;30:277–284.PubMedCrossRefGoogle Scholar
  20. 20.
    Sachdeva A, Dalton M, Amaragiri SV, Lees T. Elastic compression stockings for prevention of deep vein thrombosis. Cochrane Database Syst Rev. 2010;(7):CD001484Google Scholar
  21. 21.
    Shorter SA. The moisture content of wool — its relation to scientific theory and commercial practice. Journal of the Society of Dyers and Colourists. 1923;39:270–276.CrossRefGoogle Scholar
  22. 22.
    Kerr NC, et al. A comparison of the effects of microorganisms and freezing on the degradation of wool. Biodeterioration and Biodegradation 9. E. G. Edyvean, Institute of Chemical Engineers. 1995;96-100.Google Scholar
  23. 23.
    Leeder JD. Chapter 3: Wool the super sorber. In: Leeder JD. Wool — Nature’s Wonder Fibre. Ocean Grove, Vic: Australasian Textile Publishers; 1984:13–16.Google Scholar
  24. 24.
    Levin E, Mackintosh D, Baker T, Weatherall M, Beasley R. Effect of sitting in ergonomic chairs on lower limb venous blood flow. Occupat Ergonom. 2009;8:125–132.Google Scholar
  25. 25.
    Hsieh HF, Lee FP. Graduated compression stockings as prophylaxis for flight-related venous thrombosis: systematic literature review. J Adv Nurs. 2005;51:83–98.PubMedCrossRefGoogle Scholar
  26. 26.
    de Groot PCE, Bleeker MWP, Hopman MTE. Ultrasound: a reproducible method to measure conduit vein compliance. J Appl Physiol. 2005;98:1878–1883.PubMedCrossRefGoogle Scholar
  27. 27.
    Gaitini D. Current approaches and controversial issues in the diagnosis of deep vein thrombosis via duplex Doppler ultrasound. J Clin Ultrasound. 2006;34:289–297.PubMedCrossRefGoogle Scholar
  28. 28.
    Wright HP, Osborn SB. Effect of posture on venous velocity, measured with 24NaCl. Br Heart J. 1952;14:325–330.PubMedCrossRefGoogle Scholar
  29. 29.
    Hitos K, Cannon M, Cannon S, Garth S, Fletcher JP. Effect of leg exercises on popliteal venous blood flow during prolonged immobility of seated subjects: implications for prevention of travelrelated deep vein thrombosis. J Thromb Haemost. 2007;5:1890–1895.PubMedCrossRefGoogle Scholar
  30. 30.
    Kalodiki E, Ellis M, Kakkos SK, Williams A, Davies AH, Geroulakos G. Immediate hemodynamic effect of the additional use of the SCD EXPRESS compression system in patients with venous ulcers treated with the four-layer compression bandaging system. Eur J Endovasc Surg. 2007;33:483–487.CrossRefGoogle Scholar
  31. 31.
    Delis KT, Knaggs AL, Sonecha TN, Zervas V, Jenkins MP. Lower limb venous haemodynamic impairment on dependency: quantification and implications for the “economy class” position. Thromb Haemost. 2004;91:941–950.PubMedGoogle Scholar
  32. 32.
    Partsch H, Winiger J, Lun B. Compression stockings reduce occupational leg swelling. Dermatol Surg. 2004;30:737–743.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Healthcare 2011

Authors and Affiliations

  • Thomas Charles
    • 1
    • 2
  • Deborah Mackintosh
    • 3
  • Bridget Healy
    • 2
    • 4
  • Kyle Perrin
    • 2
    • 4
  • Mark Weatherall
    • 4
    • 5
  • Richard Beasley
    • 2
  1. 1.Medical Research Institute of New ZealandWellingtonNew Zealand
  2. 2.Medical Research Institute of New ZealandWellingtonNew Zealand
  3. 3.Pacific Radiology LimitedWellingtonNew Zealand
  4. 4.Capital & Coast District Health BoardWellingtonNew Zealand
  5. 5.University of Otago WellingtonWellingtonNew Zealand

Personalised recommendations