Compression stockings/ Venous disorders

The right diagnosis is essential

Prescribing Ccl 1 compression stockings

From Bauerfeind Life Magazin

In short Some phlebological conditions only require the use of medical stockings with compression class 1. Bauerfeind life asked two experts from a dermatological hospital and a specialist practice about their experiences.

  • Medical compression stockings with compression class 1 are refundable, do not impact the physician’s budget, can significantly reduce pain and are well accepted by patients.
  • Prof. Dr. Birgit Kahle, Deputy Director for Phlebology and Surgical Dermatology at Schleswig-Holstein University Hospital on the Lübeck Campus, has achieved excellent results with Ccl 1, for example in post-operative care, with pregnant patients or patients with jobs that require a lot of standing.
  • Dr. Christine Zollmann, co-owner of a joint practice for vein and skin conditions in Jena, also prescribes compression class 1 to elderly patients because it is easier for them to put on.
  • In its current guideline, the German Society of Phlebology (DGP) recommends using the lowest effective compression class to support compliance.

Which phlebological conditions only require the use of medical stockings with compression class 1? Bauerfeind life asked two experts from a dermatological hospital and a specialist practice about their experiences.

Prof. Dr. Birgit Kahle is the Deputy Director for Phlebology and Surgical Dermatology at the Department of Dermatology, Venereology and Allergology (Vein Competence Center plus) at Schleswig-Holstein University Hospital on the Lübeck Campus.

“Compression class 1 achieves excellent results”

“In my department, Surgical Dermatology and Phlebology, the proportion of phlebological conditions is about 50 percent. That includes the entire spectrum of varicose veins, venous leg ulcers, thrombosis, post-thrombotic syndromes, pulmonary embolisms and vascular malformations. We prescribe medical compression stockings for all lymphatic and venous conditions and in accordance with the symptoms. Pregnant women or patients with jobs that require a lot of standing also come to us, and we can prescribe stockings if they have mild edema. But they’re not suitable for preventing medical conditions, such as varicose veins. You can only combat the symptoms once they have occurred.

I prescribe compression class 1 quite often. It has been approved and available for prescription for many years. The guidelines specified by the German Society of Phlebology recommend using the lowest compression class to begin with. We achieve excellent results, for example in post-operative care and with patients suffering from concomitant peripheral artery disease. There’s not much difference in contact pressure compared with compression class 2. Our patients are very happy with it and get on easily with the stockings because donning is less complicated. And they are very effective. A recent study using MRI has shown that Ccl 1 even has a beneficial effect on patients with venous disorders when they’re lying down and don’t move. Of course, patients do have to wear the stockings. If patients don’t seem interested or give the excuse during an appointment that they just happen not to be wearing the stockings today as an exception, I will no longer prescribe them. Patients who turn to me requesting treatment will receive the relevant treatment, but I will not try to convince anyone. My experience has shown: those who really do have problems will regularly wear the compression stockings and will return every six months for their follow-up prescription. But that doesn’t depend on the compression class and is more a fundamental issue.”

Dr. Christine Zollmann, specialist in dermatology and venereology with the additional focus on phlebology and allergology, is a co-owner of a joint practice for vein and skin conditions in Jena, Germany.

“Patient compliance is great”

“In our practice for vein and skin conditions, we prescribe medical compression stockings for all phlebological symptoms where required. In cases of varicose veins, for example, following varicose vein surgery, acute or healed thrombosis or severely impaired arterial circulation. I prescribe compression class 1 in cases of mild edema, for pregnant women, too, who have a tendency toward swelling or a strong sensation of heaviness, in cases of gravitational edema and varicose veins that are less pronounced. Those affected even notice significant relief with Ccl 1. I prescribe them to older patients, too, who have difficulty putting on class 2 compression stockings because they find it harder to bend down or suffer from osteoarthritis in the hands. In relation to all four compression classes, the proportion of Ccl 1 is 10 to 15 percent. Most of our prescriptions are compression class 2.

As a basic principle, I don’t prescribe compression stockings as early as possible but after a definitive diagnosis. For prevention, on long flights for example, people can wear light stockings without a medical indication. But you have to buy them yourself. On long journeys, we also recommend getting up regularly, walking around and drinking a lot. If the varicose veins aren’t in the thigh area, if thrombosis is subsiding or if the cause has been treated in venous leg ulcer patients and the wound has healed, knee-high stockings instead of long pantyhose are enough, especially in the summer. Ideally, patients should wear the stockings all day until they can put their legs up in the evening. Some initially oppose compression stockings. But when the diagnosis is right, compliance is great. The lovely soft material convinces most people that they should go to a medical supply retailer – even the most skeptical men.”

With Ccl 1, those affected notice a significant reduction in symptoms.

Compression classes: start low

The four compression classes (Ccl) for medical compression stockings (MCS) describe the resting pressure in the ankle area: mild, moderate, strong, very strong (1–4). All Ccl can be prescribed. During everyday practice work, compression class 2 is used most often. In their guidelines, the German Society of Phlebology (DGP) is against a strict allocation of compression classes to go with a diagnosis1. The DGP recommends using the lowest compression class that is effective to support compliance with compression therapy. In cases of varicose veins without pronounced edema, for example, Ccl 1 can already eliminate symptoms.

Images: Bauerfeind, shutterstock.com/ArtFamily/Alex Kh, privat

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