Clinical comparison of elastic supports for venous diseases of the lower limb and thrombosis prevention.

There is little objective evidence available when prescribing aids and appliances such as elastic supports for the leg. Doctors are generally ill-informed about effectiveness, fitting and costs of these garments. The claims of competing suppliers cannot be applied to clinical situations because the garments are tested in vitro on rigid forms. Elastic support for the lower limb is required in the treatment of varicose veins and gravitational disease and has been found effective in prevention of deep venous thrombosis. This study examined the in vivo effectiveness of four commercially purchased garments for these two purposes. The legs of 40 patients with varicose veins, 12 with gravitational disease and 20 patients admitted for elective operations were studied. Pressure exerted by the garment was detected by partly fluid filled bags between garment and limb. The results in patients with varicose veins and gravitational disease were similar. Only two garments exerted effective pressure and of these two the combination of a roller bandage and tapered tubigrip is recommended on grounds of least expense and ease of application. Of the four anti-embolism supports only the roller bandage plus tapered tubigrip produced effective compression: two garments produced reversed flow gradients in the majority of tests. Elastic supports should be double tested, firstly by the manufacturer for basic stretch and regain characteristics and secondly in vivo by clinicians to provide objective evidence of cost effectiveness.