Compression Stockings with a Negative Pressure Gradient Have a More Pronounced Effect on Venous Pumping Function than Graduated Elastic Compression Stockings

ObjectivesTo measure the effect on the venous pumping function of a stocking providing a negative pressure gradient with higher pressures over the calf in comparison to a conventional graduated elastic compression stocking (GECS) in patients with advanced venous insufficiency.DesignExperimental study.Material30 patients with severe superficial chronic venous insufficiency were enrolled. Two elastic stocking designs exerting a pressure at ankle between 15 and 25 mm Hg were compared; a conventional GECS and a stocking exerting a higher pressure over the calf than over the ankle producing a “progressive” increase in compression (PECS).Methodthe venous calf pumping function was assessed by measuring the ejection fraction (EF) from the lower leg by a plethysmographic method during a standardised exercise. Interface pressure of the 2 compression devices was simultaneously recorded both at B1 = 12 cm above ankle, C = just above widest part of calf.ResultsThe mean increase of EF produced by PECS was +75% (95 CI 48,7-101,3) compared with +32% (95%CI 16,8-48,6) with GECS (P < 0.001). There was a significant correlation between EF and the stocking pressure measured at calf level during standing and walking.ConclusionStockings exerting a higher pressure on the calf than on the ankle show a greater efficacy in increasing the venous ejection fraction from the leg.