Medical compression socks and stockings are prescribed by a doctor for various venous and lymphatic ailments. However, there are times that a compression garment is not ideal. A compression garment should not be worn in the case of circulation disorders in leg arteries or for those with serious heart conditions.

Caution is also recommended in the case of sensory impairments due to diabetes and neuropathy (nerve damage).

Common comorbidities in compression therapy

The Bonn Vein Study shows that the likelihood of comorbidities such as diabetes mellitus (with possible polyneuropathy = PNP) or PAD, peripheral arterial disease, increases with age. Both comorbidities are considered risk factors and – depending on their severity – even as a contraindication to compression therapy.2 Therefore, special care must be taken.

Although mild or moderate PAD (ABI < 0.9 and > 0.5) are risk factors for compression therapy, compression can be performed if the expected benefit outweighs the possible harm.2 This form of peripheral arterial occlusive disease (Fontaine stage I – II or Rutherford category 1 – 3) affects about 21 percent of people over 65 years of age.3

ABI Assessments can help determine if patients have PAD. An ABI assessment can help diagnose those at risk to save lives, limbs and the cost of care. At medi, we offer the one-minute MESI ABI assessment that can help showcase if patients are safe to compress. 

In addition, PAD can lead to functional and structural changes in the skin and soft tissue due to the lack of supply, i.e., soft tissue atrophy. Due to the regression of the tissue, the important protective and cushioning function on the foot is lost, bony prominences become more prominent, which increases the risk of critical pressure points.

For these patients, a medical compression stocking must meet special requirements in order to even be used. Frequently, these two comorbidities – diabetes mellitus and PAD – are also associated.

Specific challenges in patients with PAD and/or diabetes mellitus:

  • general tissue atrophy
  • trophic disorders of the skin
  • sandpaper-like hyperkeratosis
  • trophic edema
  • Hyperkeratosis at pressure-exposed sites
  • dry skin

Special requirements for medical compression therapy for comorbidities

The international consensus document on risks and contraindications in medical compression therapy confirms the need for specific properties of the compression material in vein patients with concomitant PAD and/or diabetes mellitus.4

It is recommended that each patient receiving medical compression therapy be screened in advance for the presence of possible risk factors. These include advanced PAD and advanced microangiopathy, often present in the context of diabetes mellitus.

Special precautions are suggested for patients with polyneuropathy or loss of sensitivity, for example as a result of diabetic neuropathy. These include things like cushioning bony prominent structures and checking the fit & accuracy.

For every patient with an ABPI (ankle-brachial pressure index) < 0.9, the effect of medical compression therapy should be closely monitored.

Advanced PAD should be considered as a contraindication if one of these parameters applies: ABPI < 0.5, ankle artery pressure < 60 mmHg, toe pressure < 30 mmHg or TcPO2 < 20 mmHg ankle.

Severe sensory disturbances of the limb and advanced peripheral neuropathy (e.g., in diabetes mellitus) should be considered as risks.

“In order to avoid side effects and risks of compression therapy, the rules of proper implementation should be observed. This includes the padding of pressure-prone areas and regular skin care (S2k guideline recommendation 33 – highest level of evidence “should”)”.

There are 200 million people globally who have Peripheral Arterial Disease and approximately 40% of the population has chronic venous insufficiency.

While those with severe PAD (ABI<0.51) are contraindicated for compression therapy, the mediven® angio has been proven safe to use for diabetic and PAD patients in the mild-to-moderate ABI testing range.

There is a helpful infographic that shares when it is safe to wear compression and when it is not depending upon a patient’s venous state.

In addition, even for those who are prescribed to wear compression, it is best practice to remove your medical compression stockings when you go to sleep. Your venous and lymphatic system does not work against gravity when you lie down. This facilitates the drainage of blood and lymph. In addition, skin regenerates overnight. So, for those who continuously wear compression during the day, it is advised to not wear medical compression stockings at night.

Your physician will advise you on the best approach for using compression with specific underlying conditions.

References:

1 Rabe E et al. Bonn vein study of the German Society of Phlebology. Phlebology 2003; 32:1–14.

2 Rabe E et al. S2k Guideline: Medical compression therapy of the extremities with medical compression stocking (MKS), phlebological compression bandage (PKV) and medical adaptive compression systems (MAK). Published online at: www.awmf.org/leitlinien/detail/ll/037-005.html (last accessed 08.09.2021).

3 Lawall H et al. S3 guideline for the diagnosis, therapy and follow-up of peripheral arterial occlusive disease. Published online under: www.awmf.org/leitlinien/detail/ll/065-003.html (Last accessed 08.09.2021)

4 Rabe E et al. Risks and contraindications of medical compression treatment – A critical reappraisal. An international consensus statement. Phlebology 2020;35(7):447–460.