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Society of Vascular Surgery and American venous Forum Recommendations on compression stockings

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    Here are excerpts from the Society for Vascular Surgery (SVS) and the American Venous Forum (AVF) clinical practice guidelines for the care of patients with varicose veins of the lower limbs.

    Recommendations of the Venous Guideline Committee are based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system as strong (GRADE 1) if the benefits clearly outweigh the risks, burden, and costs.

    The suggestions are weak (GRADE 2) if the benefits are closely balanced with risks and burden.

    The level of available evidence to support the evaluation or treatment can be of high (A), medium (B), or low or very low (C) quality.

    The key recommendations of these guidelines are:

    1) Patients with varicose veins or more severe chronic venous disease, a complete history and detailed physical examination are complemented by duplex ultrasound scanning of the deep and superficial veins (GRADE 1A).

    2)  The CEAP classification should be used for patients with chronic venous disease (GRADE 1A).

    3) They recommend the use of the revised Venous Clinical Severity Score (VCSS) used to assess treatment outcome (GRADE 1B).

    They suggest compression therapy for patients with symptomatic varicose veins (GRADE 2C) but recommend against compression therapy as the primary treatment if the patient is a candidate for saphenous vein ablation (GRADE 1B).

    The study was published by Peter Glovickzi, Anthiny J Comerota, Michael C Dalsing, Bo G Ecklof, David L Gillespie, Monika L Glovickzi, Joanne M Lohr, Robert M McLafferty, Mark H Meissner, M Hassan Murad, Frank T Padberg, Peter J Pappas, Marc A PAssman, Joseph D Rafetto, Michael A Vasquez, Thomas A Wakefield.  JVasc Surg 2011; 53: 2S-48S. 

    Dr Karamanoukian's comment:  as you can see, the level of evidence for compression stockings is poor.  However, all insurance companies require that patients try wearing compression stockings before any intervention for venous insufficiency or varicose veins.