title: Are compression stockings an effective treatment for orthostatic presyncope?
abstract: BACKGROUND
  Syncope, or fainting, affects approximately 6.2% of the population, and is associated with significant comorbidity. Many syncopal events occur secondary to excessive venous pooling and capillary filtration in the lower limbs when upright. As such, a common approach to the management of syncope is the use of compression stockings. However, research confirming their efficacy is lacking. We aimed to investigate the effect of graded calf compression stockings on orthostatic tolerance.
  
  
  RESULTS
  We evaluated orthostatic tolerance (OT) and haemodynamic control in 15 healthy volunteers wearing graded calf compression stockings compared to two placebo stockings in a randomized, cross-over, double-blind fashion. OT (time to presyncope, min) was determined using combined head-upright tilting and lower body negative pressure applied until presyncope. Throughout testing we continuously monitored beat-to-beat blood pressures, heart rate, stroke volume and cardiac output (finger plethysmography), cerebral and forearm blood flow velocities (Doppler ultrasound) and breath-by-breath end tidal gases. There were no significant differences in OT between compression stocking (26.0±2.3 min) and calf (29.3±2.4 min) or ankle (27.6±3.1 min) placebo conditions. Cardiovascular, cerebral and respiratory responses were similar in all conditions. The efficacy of compression stockings was related to anthropometric parameters, and could be predicted by a model based on the subject's calf circumference and shoe size (r = 0.780, p = 0.004).
  
  
  CONCLUSIONS
  These data question the use of calf compression stockings for orthostatic intolerance and highlight the need for individualised therapy accounting for anthropometric variables when considering treatment with compression stockings.
authors.affiliation: Department of Biomedical Physiology and Kinesiology, School of Engineering Science, Simon Fraser University, British Columbia, Canada.
authors.forename: Clare Louise
authors.initials: CL
authors.lastname: Protheroe
authors.forename: Anastasia
authors.initials: A
authors.lastname: Dikareva
authors.forename: Carlo
authors.initials: C
authors.lastname: Menon
authors.forename: Victoria Elizabeth
authors.initials: VE
authors.lastname: Claydon
mesh_terms: D000328:Adult; D000842:Ankle / Q000503:physiopathology; D000886:Anthropometry; D001783:Blood Flow Velocity / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology; D002302:Cardiac Output / Q000502:physiology; D004244:Dizziness / Q000150:complications* / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006706:Homeostasis; D006801:Humans; D008297:Male; D054971:Orthostatic Intolerance / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D053828:Stockings, Compression; D013318:Stroke Volume / Q000502:physiology; D013575:Syncope / Q000150:complications* / Q000503:physiopathology / Q000628:therapy*