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The AG design of the VenoTrain ulcertec Proven edema reduction in the thigh area

Issue 03/2021

The VenoTrain ulcertec compression stocking system has been designed for the treatment of venous leg ulcers. For patients where the edema has moved to the thigh, there is now a product version with a longer liner – with its own product subgroup in the German Medical Aids Directory1. The effectiveness of this stocking has been verified in a study conducted at Greifswald University Hospital, Germany..

Venous leg ulcers are one of the most common chronic wounds. According to the Bonn Vein Study, 0.7 percent of adults in Germany suffer from it (active or healed, or stage C5 and C6 as per CEAP classification). The incidence of this condition increases with age, to five percent in those over 82, for example2. In addition to a slow healing process, chronic wounds are usually associated with pain and/or discomfort. This is a huge burden for those affected. Furthermore, chronic venous leg ulcers cause high treatment costs. The problem is worsened because the condition is usually progressive and tends to recur. The primary treatment goal for venous leg ulcers is the reduction of pressure and volume straining the venous system.

Good experiences with the compression stocking system

At Greifswald University Hospital’s Clinic and Outpatient Clinic for Skin Diseases, physicians have been using the VenoTrain ulcertec compression stocking system for a long time to treat venous leg ulcers. Not least because its superiority has been verified in a multi-center clinical study compared with multi-layer short-stretch compression bandages when it comes to healing rate and duration – at significantly lower costs (also see box on page 31). “Our experiences with the VenoTrain ulcertec as a knee-high stocking have been exceptionally good,” confirms Resident ­Physician Dr. med. Wolfgang Konschake. “Both in studies and during everyday clinical routine. When this compres­sion stocking system is worn, it’s not just venous leg ulcers that heal more quickly, but other wounds as well.” In his opinion, the stocking system is well ahead of phlebological compression bandages: “With the
compression stocking, the contact pressure is in a therapeutically effective range (37 mmHg). Another huge advan­tage of the two-component stocking is that it allows wound treatment and skin care with ointments and creams without any problems: the wound dressing is secured with the liner that can and should also be worn at night. Our patients get on well with the system.”

The VenoTrain ulcertec compression stocking system has been specifically designed for use on the lower leg. “During everyday use, however, we kept observing that, in patients with pronounced edema in the lower leg, the edema also moved into the thigh,” Dr. Konschake reports. “Those affected then expressed the typical symptoms associated with CVI for the thigh as well, such as a feeling of tension and heavy legs.”

Dr. med. Wolfgang Konschake is a specialist in skin and venereal diseases at Greifswald University Hospital’s Clinic and Outpatient Clinic for Skin Diseases.
Dr. med. Wolfgang Konschake is a specialist in skin and venereal diseases at Greifswald University Hospital’s Clinic and Outpatient Clinic for Skin Diseases.

Study on VenoTrain ulcertec using the AG design

Bauerfeind picked up on the suggestions from clinical practice and developed another product version where the liner goes up to the thigh. This model is listed in a separate product subgroup “two-component knee-high stockings with thigh-high liner” in the German Medical Aids Directory. Supervised by Prof. Dr. med. Michael Jünger, Dr. Konschake and his colleagues examined how this version stands the test in a prospective controlled study3. They compared the VenoTrain ulcertec’s effectiveness, undesirable side effects and hemodynamic effects in two thigh-high versions (AG) ‘moderate’ with the known lower leg design (AD) in patients with stage C3 to C6 CVI. 

Effective drainage

13 patients were included in the study. They wore the three VenoTrain ulcertec sets for one week each: AD moderate (37 mmHg), AG moderate (37 mmHg) and AG (45 mmHg). There was always one week’s break in between the individual wearing phases. The leg volume measurements of the lower leg and thigh were taken with the Bodytronic 600, the measurement of the ejection fraction and venous reflux using strain-gauge plethysmography at the forefoot. Symptoms and undesirable side effects were documented with a questionnaire.

“All three stockings resulted in a reduction in lower leg volume. We also found out during the measurements that the thigh volume increased slightly with the stockings for the lower leg. The two AG versions reduced the thigh volume as expected,” Dr. Konschake reports. “What surprised me was that the thigh-high compression stockings also resulted in better lower leg drainage even though exactly the same pressure was exerted at the lower leg with the 37 mmHg stockings as with the conventional VenoTrain ulcertec knee-high stocking set. The AG stocking with a contact pressure of 37 mmHg performed best,” the resident physician reports.

Improved venous hemodynamics

The rhomboid knit ensures a high degree of working pressure during movement.
The rhomboid knit ensures a high degree of working pressure during movement.

Another important result the Greifswald team was able to find was that all three compression stocking systems tested significantly improved venous hemodynamics, drainage function and the venous filling index. “It was interesting to see that the measurements confirmed that, for AG stockings, the version with a contact pressure of 37 mmHg was absolutely sufficient from a hemodynamic perspective. In our study, the firmer stocking didn’t have any advantages concerning hemodynamics or leg drainage,” Dr. Konschake states. What conclusion does the physician draw from this for future venous leg ulcer treatment? “Wherever possible, we should also try to improve thigh drainage in patients with venous leg ulcers. In principle, a thigh-high stocking would be ideal for most patients. But the question is: would they tolerate that?”

A lack of acceptance is a known and wide-spread problem when it comes to compression garments. “That’s why we also asked as part of the study whether donning the stockings – the long ones in particular – was more difficult and what the general wearing comfort was like,” Dr. Konschake explains. “In terms of compliance, the two thigh-high stockings also did very well.

Donning was not more difficult, even for the AG stocking with the higher compression, which one might assume.” In addition, the study surveyed typical unpleasant side effects of a compression stocking, such as dry legs, itching, tingling, feeling cold and sweating. “All the patients gave low ratings – none of the stockings stood out in any way,” Dr. Konschake says.

The physician firmly believes: “My preference would always be to treat leg ulcer patients suffering from chronic venous insufficiency with a clinically visible manifestation in the thigh with a thigh-high compression stocking set. You can explore the patient’s acceptance to do this in advance.”

Digital measurements for an ideal fit

Another aspect relating to compression stockings is important to the young physician: “The stockings have to fit perfectly! Ideally, the measurements for the stockings should be taken with a digital measurement system. This has huge advantages compared with a tape measure.”

He has also come to appreciate these systems for his own research activities. “For other studies, I’ve worked with the previous system but also with simple methods like water plethysmography. With the Bodytronic 600, circumferences can be measured at different heights and the corresponding volumes determined automatically. No physical contact is needed, data is saved permanently, and the results are precise and reproducible. It’s a dream come true for any scientist!”

VenoTrain ulcertec vs. compression bandage:
Stocking system significantly superior

In 2004, a randomized prospective multi-center study led by Dr. med. Michael Jünger, Greifswald University Hospital, was the first to confirm the superior effectiveness of the newly developed VenoTrain ulcertec compression stocking system for leg ulcers compared with conventional phlebological compression bandages (PCB).1 In the study, 121 patients with venous leg ulcers were treated for a period of twelve weeks or until the ulcers had healed. The results showed the significant superiority of the stocking system, with a healing rate of 47.5 percent compared with 31.7 percent for the multi-layer short-stretch compression bandage. In addition, 30 percent more mobility was observed when using the VenoTrain ulcertec. Patients gave the handling of the stocking system a very high rating, and the compression stocking also came off better with health care professionals, for example in terms of treatment effect, burden and compliance.

The compression stocking system resulted in higher healing rates compared with the PCB – along with better wearing comfort and greater acceptance among care staff – and even brought about lower costs. An economic examination based on data from the ulcertec study showed that, when using the VenoTrain ulcertec, up to 34 percent of treatment costs for each healed case could be saved, compared with PCB treatment2,3.

1 Jünger M., Wollina U., Kohnen R. et al., Efficacy and tolerability of an ulcer compression stocking for therapy of chronic venous ulcer compared with a below-knee compression bandage; results from a prospective, randomized, multicenter trial, Curr Med Res Opin 20 (10): 1613–1624, 2004.
2 Prof. Dr. Hans-Werner Stahl, Betriebswirtschaftlicher Vergleich unterschiedlicher Therapieverfahren zur Behandlung des Ulcus cruris venosum im Rahmen der Ulcertec-Studie, Euro-Management-Institut, Reutlingen, July 2004.
3 Cost of treatment with VenoTrain ulcertec set
at 100 percent.

Study folder available

The effectiveness and economic efficiency of the VenoTrain ulcertec compression stocking system for the treatment of venous leg ulcers have been verified in several studies.
The results have been summarized in detail in a brochure. It can be requested by e-mail from: medical.affairs@bauerfeind.com

1  Two-component knee-high stockings with thigh-high liner
2 Rabe E. et al.: Bonner Venenstudie der DGP, Phlebologie 1, 2003, 32: 1–4.
3 Konschake W., Riebe H., Pediaditi P., Haase H., Jünger M., Lutze S.: Compression in the treatment of chronic
venous insufficiency: Efficiacy depending on the length of the stocking. Clin Hemorheol Microcirc. 2016; 64 (3): 425–434.

Images: Bauerfeind, Stefan Volk


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