Quantified hemodynamics of compression garments

Various forms of compression therapy have been utilized for centuries in the treatment of venous disease, with inelastic bandage systems being used in the more acute treatment of severe venous disease and elastic compression stockings used for long-term management of the disease. However, with the advancement in inelastic adjustable compression wraps, we now have the option to consider long-term management of venous disease with an inelastic system and not just elastic systems. The aim of this study was to compare the hemodynamic effect of elastic compression stockings and inelastic compression wraps on venous disease patients when both products are applied to provide the same level of compression. Utilizing the APG device (ACI Medical, San Marcos, CA, USA), venous volumes, venous filling indexes and ejection fraction measurements were captured on 10 patients with varying degrees of venous disease. Measurements were obtained for each patient at baseline (without compression), with either 30-40 or 20-30 mmHg elastic compression stockings (ECS) and an inelastic compression wrap (ICW) (Juxta-CURES^tm by Circaid Medical, San Diego, CA, USA). The compression level of the ECS was measured at the B1 point utilizing a Picopress® [Microlab Elettronica Sas, Roncaglia di Ponte San Nicolò (PD), Italy] and the ICW was adjusted to provide the exact compression level as the ECS in order to compare the effects of inelasticity versus elasticity independent of compression differences. As expected, the use of compression therapy significantly improved all measures of hemodynamics although it was found that the ICW (average static stiffness 14.3) further improved the measures over ECS (average static stiffness 2.4). Average venous volumes were reduced over baseline with ECS by 19% while ICW showed a reduction of 35%. Average venous filling indexes were reduced with ECS by 25% and 39% with ICW. The ejection fractions for both devices, ECS and ICW, improved an average of 27%. When applying the same compression level, the stiffness associated with ICW can further improve the venous hemodynamics of venous disease patients over ECS. For certain patients, using ICW could prove to be a significant benefit in the management of their disease.