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I enjoyed reading the article by Jeffrey Ginsberg and colleagues on post-phlebitic syndrome.¹ I would like to share my observations from 15 years of treating swollen legs related to varicose veins, leg ulcers, post-phlebitic leg and lymphedema. I am not a scientist, but as a result of my clinical experience I believe that compression support knee-highs are superior to extremity pumps because they provide continuous pressure while allowing a patient to ambulate. In my estimate, support knee-highs are one of the least understood and most underused treatment modalities in medicine.

Patients usually initially require stockings that provide 20-30 mm Hg of compressive pressure, which can be reduced to 8-15 mm Hg once the patient's condition has improved. These stockings should be worn indefinitely, a notion patients often resist. Resistance can be overcome through counselling, referral to experienced fitters in designated pharmacies and instruction in the use of devices to assist aged hands with putting on the stockings. My preferred length is the knee-high because it most easily allows for ambulation.

As an aside, I have also observed that patients with post-phlebitic syndrome seem to present more often than the general public with concomitant varicose veins. Treating varicose veins with surgery, sclerotherapy or compression seems to relieve most of the signs and symptoms of post-phlebitic syndrome.

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^SOURCE:Monika Moniuszko, MD,  Vein Clinic; Edmonton, Alta.

Reference

1. Ginsberg JS, Magier D, Mackinnon B, Gent M, Hirsh J. Intermittent compression units for severe post-phlebitic syndrome: a randomized crossover study. CMAJ 1999;160(9):1303-6

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