Hrev_master Veins and Lymphatics 2018; volume 7:7634 Patient compression compli- ance: Winning the battle Terri Morrison Terri Morrison Consulting, LLC, Morrison Vein Institute, Scottsdale, AZ, USA Introduction In patients with incompetent great saphenous veins, pelvic veins, accessory veins, refluxing perforators and venous malformations, and leg ulcers, CVI is often associated with debilitating symptoms and complications. Chronic venous disease (CVD) and (CVI) Chronic Venous Insufficiency is a major public health issue carrying a high prevalence. Despite this, CVD and CVI are largely under-diagnosed and limited choices of effi- cient, effective, cost effective care is being provided to patients.1-7 Anatomic/physiologic consideration Anatomic/physiologic consideration sgould include (Figure 1): i) CEAP class, overall health; ii) improve venous return from the lower extremities with venous sta- sis; iii) counter effects of ambulatory venous hypertension; iv) help control the progression of venous and lymphatic dis- ease by increased contact of skin and der- mal tissues with capillaries. General considerations for winning the battle of patient compliance with compression Learn about compression. Compression Vendors, National and International Conferences; Use compression yourself; Research Trials with research grants; Smart fabrics, patient monitoring and pressure monitors: embedded and external use. Methods Educate and explain clear benefit for compression therapy: i) heal or prevent active venous ulceration; ii) prevention of PTS after DVT; iii) prevention of TE events after surgery when combined with anti- coagulant prophylaxis; iv) reduction of edema and inflammation; v) better cosmetic outcome (Figure 2). Technical tips: i) there are many fabrics, styles and colors available, both in ready-to- wear and custom-measured garments; ii) two facts become clear at once: Nothing fits like skin, and NO one fabric, style, brand, or type of compression is perfect for every patient (Figure 3). What did we learn after bandag- ing, velcro inelastic wraps, flat knit compression, elastic stocking compression? Adjustable velcro compression devices are more effective than inelastic bandages in reducing venous edema in the initial treat- ment phase, as described by Mosti et al.8 Results Re-adjustable AVCDs with a resting pressure of around 40 mmHg are more effective in reducing chronic venous edema than IBs with a resting pressure of around 60 mmHg. AVCDs are effective and well tolerated, not only during maintenance ther- apy, and also in the initial decongestive treatment phase of patients with venous leg edema (Figure 4). What were the venous reflux or leg ulcer recurrences? GRADE 1B: Strong compression hosiery (30-40 mmHg) is more effective than medium or low compression stockings; Grade 1A: 30-40 mmHg compression hosiery prevents recurrence of ulceration after healing. Since long-term patient concordance with compression is relatively poor, it may prove more popular, effective and cost- effective to provide a single intervention to reduce recurrence, rather than life-long treatment with compression, as described by Samuel et al.9 What are the problems and modes of treatment? Well-performed compression tech- niques do not guarantee technical success. More commonly, however, recurrent vari- cose veins can be from non-saphenous sources such as pelvic insufficiency, saphe- nous tributary incompetence, previously Correspondence: Terri Morrison, Terri Morrison Consulting, LLC, Morrison Vein Institute, Scottsdale, AZ, USA. E-mail: tm@terrimorrisonconsulting.com Conference presentation: International Compression Club (ICC) Meeting, Paris, 2017. This work is licensed under a Creative Commons Attribution 4.0 License (by-nc 4.0). ©Copyright T. Morrison, 2018 Licensee PAGEPress, Italy Figure 1. The spectrum of venous disease. [page 80] [Veins and Lymphatics 2018; 7:7634] No n- co mm er cia l u se on ly Conference Presentation [Veins and Lymphatics 2018; 7:7634] [page 81] unknown abdominal or pelvic obstruction, patient non- compliance or simple disease progression. ‘Whatever the cause, it is important to bear in mind that control of lower extremity venous incompetence can be achieved, but permanent cure is an unrealistic goal.’ Hugo Partsch Conclusions No significant, procedure related, adverse events occurred using donning and doffing methods mentioned, nor from the use of Velcro devices, circular or round knit stockings, and 4-layer bandaging with inelastic wraps and layered padding options. The battle can be won if compression reduces patient complaints of cramping, restless legs, ankle or leg swelling, heavi- ness, inflammation, pain, or recurrent leg ulcers and DVT.10-12 Compression is not a punishment, if done correctly, with the patient’s involve- ment and cooperation. References 1. Kahn SR, Shapiro S, Wells PD, et al. Compression stockings to prevent post- thrombotic syndrome: a randomized placebo-controlled trial. Lancet 2014; 383:880-8. 2. Moffatt C, Kommala D, Dourdin N, Choe Y. Factors that affect concordance with compression therapy. J Wound Care 2004;13:291-4. 3. Raju S, Hollis K, Neglen P. Use of com- pression stockings in CVD: patient compliance and efficacy. Ann Vasc Surg 2007;21:790-5. 4. Benigni J-P, Cornu-Thenard A, Uhl J-F. Criteria for non-compliance of medical compression stockings. Int J Angiol 2013;22:23-30. 5. Luire F, Kistner RL. Trends in patients reported outcomes of conservative and surgical treatment of primary chronic venous disease contradict current prac- tices. Ann Surg 2011;254:363-7. 6. Hamel-Desnos CM, Guias BJ, Desnos PR, et al Foam Sclerotherapy of saphe- nous veins: randomized controlled trial with or without compression. Eur J Vasc Endovasc Surg 2010;39:500-7. 7. Sell E. Compression therapy versus sur- gery in treatment of patients with vari- cose veins - A RCT. J Vasc Endovasc Surg 2014 [Epub ahead of print]. 8. Mosti G, Cavezzi A, Partsch H, et al. Adjustable velcro compression devices are more effective than inelastic band- ages in reducing venous edema in the initial treatment phase: a randomized controlled trial. Eur J Vasc Endovasc Surg 2015;1:e7. 9. Samuel N, Carradice D, Wallace T, et al. Endovenous thermal ablation for heal- ing venous ulcers and preventing recur- rence. Cochrane Database Syst Rev 2013;10: CD009494. 10. Ad A. Hendrickx, Wim P. Krijnen, Robert J. Damstra, Richard Bimmel, Cees P. van der Schans Compression with the Juxta Reduction Kit ® (medi) in patients undergoing a total knee arthroplasty Veins and Lymphatics 2017; 6:6622 doi:10.4081/vl.2017.6622 11. Joseph A. Caprini Velcro compression devices Veins and Lymphatics 2017; 6:6624 doi:10.4081/vl.2017.6624 12. Patrick Carpentier, Jean-François Auvert, Sophie Bensedrine, Sophie Blaise, Chantal Elbhar, Gilles Miserey, Monira Nou for the Compression Interface Group of the Société Française de Médecine Vasculaire Compression therapy in everyday life: let the patients have the floor Veins and Lymphatics 2017; 6:6625 doi:10.4081/vl.2017.6625 Figure 2. Alternate compression modalities. Figure 3. Stiff, inelastic, multilayered bandaging. No n- co mm er cia l u se on ly