Compression for comorbidities

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Common comorbidities in compression therapy for chronic venous disease: a challenge for the feet

The Bonn Vein Study shows that the probability of chronic venous disease increases with age (98 percent of people over 60 have changes in the venous system).¹ Basic therapy is medical compression in combination with exercise.

At the same time, the likelihood of comorbidities such as diabetes mellitus (with possible polyneuropathy = PNP) or peripheral arterial disease, increases with age. Both comorbidities are considered risk factors in the S2k guideline "Medical Compression Therapy" or - depending on their severity - even contraindications for compression therapy.² Therefore, special caution is required here.

Contraindications in the case of certain comorbidities

Type 2 diabetes mellitus (approximately 20.5 percent of people over 60 years of age³) can lead to damage to the peripheral nervous system: diabetic polyneuropathy. This is distally accentuated and leads in stocking-shaped spread to sensory deficits. Among other things, sensory disturbances such as numbness and insensitivity to pressure and pain occur. Patients can then no longer perceive foreign objects, for example a small stone in the shoe or folds of an incorrectly fitted stocking. Therefore, the perfect fit of the medical compression stocking (MCS) is of particular importance here. In the case of diabetic foot syndrome (DFS) with acute lesion / ulceration, compression therapy with MCS is not possible.²

Compression therapy also possible in certain comorbidities after risk-benefit analysis

Although mild or moderate peripheral arterial occlusive disease (ABPI < 0.9 and > 0.5) are risk factors for compression therapy, compression can be performed if the expected benefit outweighs the potential harm (risk-benefit analysis).² This form of peripheral arterial disease (Fontaine stage I - II or Rutherford category 1 - 3) affects approximately 21 percent of people over 65 years of age.⁴

In addition, peripheral arterial disease can lead to functional and structural changes in the skin and soft tissue due to the lack of supply: soft tissue atrophy. As the tissue recedes, the important protective and cushioning function on the foot is lost, and bony prominences become more prominent, increasing the risk for critical pressure points.

A medical compression stocking must also meet special requirements for these patients. Frequently, these two comorbidities - diabetes mellitus and peripheral arterial disease - are also associated.

Specific requirements for medical compression therapy in comorbidities

The international consensus document on risks and contraindications in medical compression therapy confirms the need for specific properties of the compression material in venous patients with coexisting peripheral arterial disease and / or diabetes mellitus.⁵

Supplementary recommendations for everyday care from the S2k guideline on medical compression therapy and the International Consensus Paper "Risks and contraindications of medical compression treatment"^{2, 5}

• It is recommended that every patient receiving medical compression therapy be screened in advance for the presence of potential risk factors. These include advanced peripheral arterial disease and advanced microangiopathy, often present in the context of diabetes mellitus. (consensus paper, recommendation 1, highest recommendation level "recommended")
• Special precautions are suggested for patients with polyneuropathy or loss of sensibility, for example as a result of diabetic neuropathy. These include padding of bony prominent structures, verification of fit, selection of a low CCL, and close monitoring. (consensus paper, recommendation 10, high recommendation level "suggested")
• In every patient with an ABPI (ankle-brachial pressure index) < 0.9, the effect of medical compression therapy should be monitored closely. (consensus paper, recommendation 14, highest recommendation level "should")
• Advanced peripheral arterial disease should be considered a contraindication if any of these parameters apply: ABPI < 0.5, ankle artery pressure < 60 mmHg, toe pressure < 30 mmHg, or TcPO2 < 20 mmHg dorsum of foot. (consensus paper, recommendation 12&13 and S2k guideline recommendation 31, highest recommendation level "should").
• Severe sensitivity disorders of the extremity and advanced peripheral neuropathy (e.g., in diabetes mellitus) should be considered as risks accordingly. (S2k guideline recommendation 32, highest recommendation grade "should").
• "To avoid side effects and risks of compression therapy, the rules of proper implementation should be observed. This includes padding of areas at risk of pressure and regular skin care (S2k guideline recommendation 33 - highest level of evidence "should")".

Study proves: mediven angio* meets these specific requirements for a medical compression stocking

A scientific study confirms that compression therapy with medical compression stockings is possible and safe for these patients.⁶

With mediven angio, a unique medical compression stocking is now available that has been developed precisely for the special requirements of these patients - with particular attention to these challenges, especially in the sensitive foot area:

This clinical study investigated the safety of patients with chronic venous disease and mild to moderate peripheral arterial disease and / or diabetes mellitus in compression therapy with mediven angio*. The scientific study proves the following for compression classes 1 and 2:⁶

• stable microcirculation
• no skin lesions
• no abrasions
• no pressure points
• high wearing comfort

Safe and patient-specific compression therapy: the medi treatment traffic light