COMPRESSION STOCKINGS of AMERICA

Support Socks for Men and Women,
Compression Stockings, Knee Highs, Thigh Highs,
Panty Hose, and Anti-Embolism Stockings

Frequently Asked Questions

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What are compression stockings?

Compression stockings are specialized long socks, which are worn from the foot to the knee/thigh. These specialized stockings have a gradient of pressure (tighter in the foot and gradually less tight at the knee). These stockings when worn properly reduce the swelling in the feet and also decrease the chance of blood clot formation in the legs.

How do compression stockings work?

Compression stockings are made of strong elastic material and fit tightly at the feet and gradually become less tight at the knee/thigh. The pressure in the stockings is graded and this allows for the stockings to constantly squeeze the leg muscles. This motion helps to drive blood back to the heart, reduce swelling in the feet and prevent blood clot formation.

Should I be wearing compression stockings?

Yes, so long as you find stockings that are comfortable for you. Light compression stocking use can reduce the feeling of heaviness in the legs, especially after standing for long periods of time. Many men and women who wear light compression stockings (15 - 20 mm Hg) report markedly less leg edema (swelling) and less aching, tiredness and discomfort in the legs. 

Can you tell me more about compression stockings?

The end result of vein problems in the legs is venous hypertension in the form of high levels of pressure in the veins during ambulation or walking. This condition is called ambulatory venous hypertension. The goals of compression therapy are several.

1. Compression Stockings help prevent clot formation in individuals who are inactive.
2. Compression Stockings help improve the return of blood from the legs.
3. Compression Stockings counter the effects of ambulatory venous hypertension.
4. Compression Stockings help control the progression of venous disease.
5. Compression Stockings reduce and control swelling in the legs (Edema)

Compression venous garments increase tissue pressure, reduce tissue swelling (edema), increase the velocity of blood flow in the veins and reduce venous reflux, which is the tendency for venous blood to flow back into the legs.

To get evaluated for the correct compression stockings, consult your Doctor.  Now, let’s discuss the goals of wearing compression stockings.

1. They must effectively treat the condition
2. They must be comfortable to wear and properly fitted
3. They have to be reasonably acceptable to wear from a cosmetic standpoint.

 

How important is it for me to be educated regarding venous conditions?

What we now know about varicose veins and spider veins and how we treat them will increase 32 fold in 8 years! Therefore, you need to be more educated and sophisticated about the treatment options that are available, so that your legs don’t become a limiting factor for you to live a long and healthy life. There are many complications associated with vein disorders, the worst of which are formation of a venous ulcers. The least important, and yet most disturbing are cosmetic concerns due to unsightly spider veins, reticular veins and varicose veins. In summary, the best advice is to get your spider veins, reticular veins and varicose veins checked on a regular basis by your Doctor and make sure you follow his instruction on the wearing of Compression Stockings.

What are Compression Stockings used to treat?

Compression stockings are an excellent and simple method of treating disorders such as chronic venous insufficiency, varicose veins, lymphedema, post phlebitic syndrome and prevention of blood clots in the leg. The stockings can be worn as either in-patient or out patient. The stockings do not eliminate the varicose veins but do help reduce the swelling, aching and heaviness feeling that individuals with varicose veins experience. It is also recommended that such stockings be worn during long plane rides to decrease the probability of blood clot formation in the legs.

Blood clot formation is a major cause of deaths in the USA and the majority of hospital protocols recommend that all patients (especially those who can't ambulate), be fitted with compression stockings.

How long should compression stockings be worn?

The stockings should be worn daily as long as patient is at increased risk of forming blood clots in the leg. The stockings should be worn during the day and removed at night. For those with varicose veins, venous ulcers and lymphedema, the stockings must be worn for years and even for life. It is highly recommended that whenever possible, individuals keep their legs elevated at night when they do not wear compression stockings. The wearing time for gradient compression stockings is dependent on both the reason for wearing the compression (indication) and the amount of compression (mm/Hg) that you've been instructed to wear. Your physician will be best able to guide you in this area.

Who should not wear compression stockings?

Compression stockings squeeze the muscles of the leg and drive blood away from the leg. In those patients who are diabetic, or those who smoke or those who have a decreased blood supply to the legs, compression stockings are not recommended. The compression stockings can decrease the blood supply further and worsen the disease.

Are there any complications associated with use of compression stockings?

There are no complications associated with compression stockings. However, they do take time to adjust to and the patient may complain of warm legs. The hot weather may occasionally deter individuals from wearing stockings all day.

Does one need a prescription to buy the stockings?

No, up to and including 20-30mm/Hg compression. A prescription is needed for 30-40mm/Hg as well as custom compression stockings. As with the purchase of any compression products it is alwasy best to consult a physician.

How much do compression stockings cost?

Depending on the compression and type of stocking, costs may run as low as $12.95. Higher compression stockings will cost slightly more. One pair may typically last for 3-6 months so long as they are properly cared for.

Does the unaffected leg need to wear compression?

Only the leg with the symptoms or disease needs to wear the compression. Some people prefer to wear compression on only the affected leg. Others may opt to wear the same brand of stocking but in a lower compression level on the unaffected or healthy leg. For example, your physician may have told you to wear a 30-40 mmHg stocking for the chronic venous insufficiency present in one leg. You may choose to wear a 15-20mm/Hg on the other leg. Always verify with your physician that the problem is present in only one leg.

Are Latex products okay to wear. What exactly is latex?

Latex is a natural substance that comes from the rubber tree. Latex can be used in textiles in two forms: Dry natural rubber and natural rubber latex. Some patients have been found to have allergies to latex and cannot be exposed to it. Compression Stockings of America are Latex-free!

When can a knee high stocking be recommended?

A knee-length gradient compression stocking is generally recommended to prevent or manage signs and symptoms of chronic venous insufficiency or other causes of lower leg swelling and skin changes. When swelling or varicosities are present above the knee then a thigh high, or pantyhose style may be a more effective choice. Again, consult with your physician for the best compression stocking for your specific condition.

Is there any benefit to layering my compression stockings, meaning can I wear one compression stocking on top of the other instead of wearing a higher compression stocking?

Yes, there is an additive effect with compression stockings. For example, some doctors instruct their patients to wear one level of compression in a pantyhose style and then wear a knee-length or knee high compression stocking over the compression pantyhose. Please consult with your physician before "layering" your compression stockings. You'll want his or her advice first.

What is Deep Vein Thrombosis

Deep Vein Thrombosis is a blood clot (thrombosis) that forms in the deep vein system of the lower leg, usually between the ankle and the upper calf. The condition is serious, potentially fatal, and very difficult to diagnose by external examination.

Symptoms, if they occur, might include muscle tension in the lower leg, a dull ache or sudden painful tear, or a cramp in the calf with swelling and elevated body temperature. Symptoms rarely occur, though, since the clot formation may develop very rapidly, detach from the wall of the vein and move through the blood stream before anyone recognizes what's happening.

The clot may travel through the veins and lodge in the heart or more likely in the lungs, resulting in sudden death. If the clot remains lodged in the legs, very serious damage may occur to the vein, or even to the leg's entire venous system. Clots can cause tissue damage, skin lesions, ulceration, and possibly removal of the limb.

Graduated compression stockings and socks have been prescribed by physicians for over fifty years to treat venous maladies such as Deep Vein Thrombosis, Varicose Veins, Phlebitis, Edema, etc. These stockings are designed to exert maximum compression at the ankle with pressure gradually decreasing up the length of the hosiery. This action forces surface veins' blood into the legs' deep vein system thereby correcting improper, weak blood flow. Graduated compression products are available in all men's and women's styles and they look and feel like regular hosiery.

Can you tell me more about Deep vein thrombosis (DVT) and Pulmonary Embolism?

Deep venous thrombosis (DVT) is the formation of blood clots in the deep veins of the legs.  This potentially life threatening condition has an incidence of about 5 to 20 Million cases per year in the U.S.

The main clinical concern with DVT is the potential of a thrombus (blood clot) to break free, travel through the inferior vena cava, through the heart, and get lodged in the vessels of the lungs. This event, called pulmonary embolism, carries a mortality rate of roughly 20 to 30%.

The formation of DVT  can be attributed to one or more of the following factors:

Venous stasis (sluggish blood flow),  Injury of the blood vessel wall, and Hypercoaguability (increased tendency of blood to clot).

Risk factors for DVT formation include age: Over the age of 40, obesity, smoking, pregnancy, trauma, IV drug use, or prolonged immobilization.  Examples here would be: Chronic illness or long trips in cars or airplanes.

People with cancer, congestive heart failure, lupus, or recent heart attack or stroke are also prone to DVT’s.  Recent surgery, chemotherapy, and hormone replacement therapy are risk factors as well.

Patients with DVT’s of the lower extremities, experience pain and swelling of the affected leg about 75% of the time. Other symptoms may include increased warmth and redness of the leg and occasionally low grade fever. DVT’s usually occur in the mid to upper leg.  DVT’s are sometimes treated by administering anticoagulants. (blood thinners)

Unless one succumbs to the complication of DVT, such as a massive pulmonary embolism, the outcomes in patients are quite good.

Please Note:  All of the information provided above is for educational purpose only.  All persons with any of the above described conditions, should see their Doctor or Personal Physician and be properly diagnosed before deceiding on Compression Stockings as their mode of treatment for their individual leg and vein conditions.

What is a varicose vein?

A varicose vein is a subcutaneous dilated vein larger than 3 mm in diameter in the upright posture. Varicose veins are also known as varix, varices and varicosities. Varicose veins can occur in both the thighs and legs. They can also occur in the medial and lateral ankles. 

How common are varicose veins?

Vein disease is ten times more common than peripheral arterial disease (PAD). Although PAD generates a lot of publicity on television ads and in the news, discussion of vein disorders have been neglected until NOW!

An estimated 27 percent of the adult population of the United States has some form of vein disease of the legs. Vein problems become more prevalent with age and can progress to the point of being disabling. As such, they should not be ignored.

The most common problems involving the venous system of the legs include varicose veins, chronic venous insufficiency and deep vein thrombosis (deep vein clots).

Of the 25 million Americans with venous insufficiency, approximately 7 million exhibit serious symptoms such as leg swelling, skin changes and venous leg ulcers.

It is estimated that in America, 72% of women and 42% of men will develop varicose veins by the age of 65. Prevalence is highly correlated to age and sex, with women having an increased likelihood of having vein problems in each age group category.

Are Varicose Veins Unhealthy?

If you experience bulging leg veins, aching and pain in the legs, heaviness, tiredness of the legs, itching and burning along bulging veins, restless legs or leg swelling, you may have symptomatic varicose veins that warrant evaluation and treatment. Varicose veins can become enlarged and in some cases quite prominent. They can be seen in some individuals as serpiginous (snakelike), raised lumps in the thighs, legs, calves and ankles.

The major superficial veins in the lower extremities include the greater and lesser (short) saphenous veins. Other veins include the superior epigastric vein, superior external pudendal vein (groin area), posterior arch vein, anteriolateral branch of the greater saphenous vein, anterior tributary vein and dorsal venous arch. As well, the posteromedial vein, vein of Giacomini, intersaphenous vein and posterior lateral tributary veins. All of these veins and their branches can become varicose.

The only place in the lower extremities where a vein should be visible is near the inner ankle bone (medial ankle), where the skin is thin. and almost everyone can see the saphenous vein cross it as it heads toward the upper body. This is seen in children and teenagers and is normal. However, any other veins that develop as we get older are ACQUIRED veins, that is they are not present when we were young but develop as we get older. As they become varicose, the overlying tissues can get inflamed and the skin can change color once blood seeps out of the veins and stains the fatty (subcutanous) tissue and skin. These hemosiderin depostis are responsible for the bronzing of the skin which is most likely at the most dependent part of the lower extremities, farthest away from the heart - the lower legs and ankle.

What Can I Do To Prevent Varicose Veins?

Many of the things that seem to cause varicose veins are difficult to avoid such as a family history or a sedentary way of life.

Whenever possible, avoid standing for prolonged periods of time. Walking is much better for the veins and helps blood return to the heart more efficiently, preventing the pooling of blood in the legs.

In professions or occupations that require extended periods of standing, a few steps should be taken at regular short intervals to help the venous circulation. These include things like wearing  Compression Support Stockings. No supplements or drugs are effective in preventing the formation of varicose veins.

Varicose veins can occur in isolation or can result from associated venous reflux disease. Venous reflux disease occurs in 10% of patients with varicose veins. However, it is important when treating varicose veins to determine if the patient has venous reflux disease. Other factors that contribute to the formation of varicose veins include obesity, hormonal changes (women), family history of varicose veins and venous stasis ulcers and male parent with varicose veins and venous reflux disease, among others.

Are varicose veins more common in men or women?

Overall, varicose veins affect 25-30 % of adult women and 15 % of adult men. Their prevalence increases with increasing age. The prevalence is higher in women who have delivered babies and women who are obese. The Edinburgh Vein Study (United Kingdom) showed that they are more common in taller individuals of both sexes.

Will elevating the lower extremities help?

If you are sitting, leg elevation at or near the level of the heart can significantly alleviate symptoms of leg pain and swelling.

Other things that you can do include:

When showering, use cold water if at all possible

Try losing weight, as this is shown to reduce saphenofemerol reflux (Venous reflux)

Avoid prolonged sitting and standing

Wear Compression Support Stockings.

What is telangiectasia, better known as spider veins?

A telangiectasia is a confluence of dilated intradermal venules of less than 1 mm in size. Telangiectasias are more commonly known as spider veins and thread veins. They can be pink, red and have different hues in the red to purple blue range. Spider veins occur in 15 % of men and 25 % of women in the general population.In the classification of veins, telangiectasias are classified as type I veins.

What is a reticular vein?

A reticular vein is a dilated bluish intradermal vein, usually from 1 mm in diameter to less than 3 mm in diameter. Reticular veins are also known as blue veins.  In the classification of veins, reticular veins are considered type III veins. Telangiectasias (type I veins) can result from refluxing reticular veins. When such reticular veins are associated with telangiectasias, they are called "feeder veins". 

What is lymphedema?

Lymphedema, unlike leg swelling (edema) due to venous reflux disease, is worse in the feet and toes. The foot and toes are involved and it has been described as having "pillow feet”.  What differentiates lymphedema from leg swelling due to venous reflux disease, is that leg elevation overnight DOES NOT relieve the edema. Also, patients rarely complain of symptoms other than the swelling. Patients with venous reflux disease complain of leg edema and heaviness and aching in the legs.

How can I tell if I have lymphedema or venous reflux disease?

Symptoms are usually lacking in patients with lymphedema. Patients with venous reflux disease typically have aching, pain, heaviness, tiredness, fatigue, cramping, throbbing and swelling in the legs. The foot and toes in lymphedema are described as "pillow feet and sausage toes" and the swelling is usually NOT relieved with overnight leg elevation.

How do vein valves work? What is venous reflux disease? What is venous insufficiency?

Legs veins have one-way valves throughout their lengths, extending from the ankles to the groins. These valves prevent blood from flowing backwards as it moves up the legs.

In essence, it is like a step ladder where blood gets pumped up into a higher level by the “leg pump” and the valve below this level closes so that blood does not go back down to the lower level. Eventually, blood clears the saphenofemoral junction and the saphenopoliteal junctions where it joins the deep veins of the leg. There are also connections between the superficial (under the skin surface) and deep veins, and these connections have valves. Venous reflux, also known as venous insufficiency occurs when these vein valves leak.

If I have Venous Ulcers that have healed, should I then wear compression stockings?

Once venous stasis ulcers have healed, graded compression stockings have to worn regularly in order to reduce the likelihood of recurrence. Recent studies show that grade II Compression Stocking (20 - 30 mm Hg) are needed and they should be worn at least to the level of the knee.  In other recently published studies, recurrence of venous stasis ulcer is 32% at 5 years when compression stockings are worn and 70% at 5 years when compression stockings are not worn.

Why are compression stockings prescribed after a blood clot (DVT) in the leg?

Knee length gradient compression stockings are often prescribed for a patient who has sustained a deep vein thrombosis (DVT) or blood clot in the leg. The stockings are helpful in controlling the swelling in the leg that occurs with DVT, and also in helping to prevent the development of post-thrombotic syndrome that may occur several months after the DVT.

What is the difference between an anti-embolism stocking and a medical compression stocking?

Anti-embolism stockings are designed specifically for bed bound (non-ambulatory) patients to help prevent blood from pooling in the veins of the leg. Pooling of blood in the veins of the leg may contribute to blood clots forming in the veins.

Anti-embolism stockings are generally made for short duration of wear during a hospitalization. Anti-embolism stockings deliver gradient compression and, depending on the manufacturer, the compression delivered to the ankle is in the range of 13-18 mmHg. These stockings are normally only available in white and beige.

After discharge from the hospital or extended care facility, if you need to continue wearing gradient compression stockings, your physician may advise you on a beginning level of compression such as 15-20 mmHg. He may also recommend a stronger compression for you such as 20-30 mmHg or 30-40 mmHg. These ranges are ideal for long term wear and comfort and are available in closed or open toe.

What is "economy class syndrome"?

Economy class syndrome is a term used to describe the medical condition deep vein thrombosis when it follows extended airplane travel. For information on which compression stocking is best for you, should you be planning an extended trip or vacation, please consult with your physician.

Can I sleep in my stockings?

Generally your stockings are made to be put on first thing in the morning and taken off when you go to bed. Only sleep in your hose when your doctor has instructed you to do so.

Can I wear my support socks or support hose when I exercise?

Yes, support socks or support hose should be worn when exercising to increase the circulation in your legs by working with your leg muscles. They help you maintain your leg health.

Does a run in compression hosiery affect the compression?

It is possible for runs to affect the compression of the garment. This depends on factors such as the severity and location of the run. For example, a single small run confined to the upper thigh or panty area will not affect the compression of the lower leg where the stated ankle pressure is determined. A localized decrease of compression may occur in the area directly under the run. If the run is moderate to severe, improved hemodynamic in the area beneath the run may not occur. As always, if you have concerns about wearing the garment please consult your medical professional.

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