International discussion Experts discuss the future of compression therapy
In March 2017, internationally recognized vascular specialists met in Zeulenroda-Triebes (Germany) to discuss the future of compression therapy. According to the participants, there is a need to research the mode of action of compression to confirm it for existing indications and use it for new areas of application.
Since mid-January, Dr. Stefanie Reich-Schupke has held the only known global professorship of phlebology at Ruhr University’s Vein Center in Bochum (Germany). With the support of Bauerfeind, she invited renowned experts such as Dr. Nick Morrison (USA), Prof. Dr. Hugo Partsch (Austria), Dr. Giovanni Mosti (Italy), Prof. Evgeny Shaydakov (Russia), Prof. Dr. Markus Stücker (Germany), and Dr. Werner Blättler (Switzerland) to a discussion where they could share their thoughts on compression therapy. A total of 23 participants gained interesting insights into new indications such as inflammatory dermatoses and neuropathic conditions. As is evident from the opinions presented below, the experts agreed that more intensive research needs to be conducted into the mode of action of compression therapy.
Dr. Nick Morrison,
USA, President of the International Union of Phlebology (IUP).
To talk about the ’Future of Compression‘ is important , because recent literature reports have brought into question the use of compression in a variety of circumstances. Well-designed scientific studies are needed to address these issues. I do not see compression therapy diminishing in the near future. However, the type of compression will certainly advance. Is there an increasing role for inelastic compression therapy in the treatment of patients with venous and lymphatic disease. A lot more research should be carried out regarding the expanded role of inelastic compression in the treatment of patients with lymphedema.
Prof. Dr. med. Stefanie Reich-Schupke,
Germany, endowed professorship of phlebology at Ruhr University Bochum.
Compression is a main corner stone of treatment in phlebology and lymphology. It can be used alone or in combination with other treatments. There is no other medication or method that can replace it. Nevertheless, we have to proof the efficacy in various indications that got under discussion e.g. thrombosis or after venous ablation. Furthermore we have to use compression in a more differentiated way. We have a large number of different materials and types of compression that all have their special advantages and disadvantages. Up to now, in many fields the standard is, compression AG, class 2‘ – often with very elastic material although the individual patient could have beneficial of another class or another material. We have to do research in many fields like acute thrombosis, postthrombotic syndrome or arterial disease and compression. We have many open questions in the field of right dose (pressure), material (elasticity, stiffness) and duration of compression e.g. after venous surgery or in leg ulcers. We have to understand more about the basics of the compression effect e.g. with regard to inflammation. If we understand more about the effect of compression we could consider new indications. Furthermore we have to think about special materials or types of compression for growing groups of patients e.g. aged or obese patients to allow them an independent therapy.
Dr. med. Werner Blättler,
Switzerland, Honorary President of the Swiss Society of Phlebology.
Compression therapy will always remain an important treatment of leg diseases. However, it will have a difficult stand if its role is not rapidly cleared on several levels. Firstly, indications brake away because imperfect studies produced negative results for compression and, secondly, because changing views of venous pathophysiology are ignored and prescription is one-sided and not patient-friendly. F.e. in Switzerland, stockings of class 1 are not reimbursed by third-party payers. Treatment with stockings class 2 leaves more patients dissatisfied than happy. Indications must be revised on the basis of available data and not on traditional believes. Physicians and manufacturers should understand that the pathophysiology of venous disorders has changed and compression therapy must be revised accordingly. This would allow marketing current products in a more adequate way immediately. Then, randomized controlled trials ought to be set up for broad and important indications as well as for specific indications. The results should be used as the basis for reimbursement of a particular product
with proven benefit in a particular indication.
Dr. Giovanni Mosti,
Italy, President of the International Compression Club.
To talk about the ‘Future of Compression’ is important , because compression therapy is not yet completely understood and, unfortunately, it is largely underused. I am sure, compression therapy will also be extremely important in the future. But it would be essential to clarify all its potential effects and show professional caregivers all the advantages that can result from its correct use. I would be very pleased if more research was done in the field of compression stockings and I would particularly welcome more knowledge in the field of ulcer patients, varicose veins and post-procedure.
Images: Andreas Wetzel