The quality of evidence is downgraded by study limitations (unclear allocation concealment, blinding, and completeness of outcome data), by inconsistency, and by imprecise results (few patients).
A Cochrane review [Abstract] 1 included 13 studies with a total of 1 021 subjects with varicose veins without healed or active venous ulceration. The stockings used in the studies exerted different levels of pressure, ranging from 10 mmHg to 50 mmHg. Five studies assessed compression stockings (3 knee-length stockings, 1 full-length stockings and 1 full tights) versus no compression stockings or placebo stockings, and 8 studies compared different types or pressures of knee-length stockings. Pooling of the studies was not possible due to the differences in the outcomes reported.
Compression stockings compared with no treatment or placebo stockings:All 4 studies that reported change in symptoms found a subjective improvement by the end of the study. Main side effects reported (3 studies) were itching and irritation, and severe side effects were not reported. One study reported a high dropout rate with low levels of compliance due to discomfort, application and appearance, and 2 studies reported generally good levels of compliance in the stocking group compared to placebo/no treatment. One study reported quality of life showing no clear differences between the stocking and placebo stocking groups.Compression stockings compared with different compression stockings:No conclusions regarding the optimum length or pressure of compression stockings could be made as there were no conclusive results from the included studies.
An RCT 2 included 153 patients with CEAP class C2-C3 and superficial venous reflux and compared conservative treatment (compression stockings) with surgery. At 2 years, 70/76 patients in the surgery group and 11/77 patients in the compression group had been operated. In the ITT analysis, the Venous Clinical Severity Score without compression stockings (VCSS-S) decreased 1.1 points in the compression group and 4.2 in the surgical group (p < 0.001). Corresponding Venous Segmental Disease Score (VSDSs) were 7.7 and 7.0 (n.s.) in the compression group, and 8.2 to 0.9 in the surgery group (p < 0.0001). At baseline, 95% of the patients in both groups had a Venous Disability Score (VDS) of I (i.e. patients were symptomatic but able to carry out daily activities without compression therapy), and at the 2-year follow-up, the VDS was 0 for 10.0% (7/70) of the patients in the compression group and for 70.6% (48/68) in the surgery group. Health-related quality of life (HRQoL) did not change in the compression group but improved significantly in the surgery group.
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