title: Hemodynamic changes at the saphenofemoral junction during the application of a below-knee graduated compression stocking.
abstract: BACKGROUND
  It is strongly recommended that patients wear compression after foam sclerotherapy, but pulling up a stocking may inadvertently flush foam into the femoral vein, which may increase the risk of systemic side effects and reduce great saphenous vein (GSV) occlusion rates.
  
  
  OBJECTIVE
  The hypothesis was that a stocking pull-up maneuver would increase flow in the GSV. The aim was to quantify this using duplex ultrasound.
  
  
  METHODS
  Twelve consecutive patients with primary varicose veins were studied. A below-knee 23- to 32-mmHg graduated elastic compression stocking was placed over the foot, leaving a cuff of redundant stocking around the ankle. Duplex ultrasound over the saphenofemoral junction was used to measure peak velocity (PV) and volume flow (VF) before and while the stocking was being pulled up.
  
  
  RESULTS
  The pull-up maneuver caused a median 17.7 times increase in PV (interquartile range (IQR) 14.2-23.9), from 7.6 cm/seconds (IQR 6.4-9.8 cm/seconds) to 150.5 cm/seconds (IQR 110-187 cm/seconds) and a 9.4 times increase in VF (IQR 7.7-10.3), from 50.9 mL/minutes (IQR 33.8-78.9 mL/minutes) to 458.7 mL/minutes (IQR 292.1-593 mL/minutes) (p = .002).
  
  
  CONCLUSIONS
  A stocking causes significant hemodynamic changes within the GSV. These forces could be avoided by the partial application of a stocking to knee level before foam injection. Further work may establish the implication of these findings in patients treated with foam sclerotherapy.
authors.affiliation: Ealing Hospital and Imperial College, Uxbridge Road, Southall, Middlesex, UK. c.lattimer09@imperial.ac.uk
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Lattimer
authors.forename: Mustapha
authors.initials: M
authors.lastname: Azzam
authors.forename: Evi
authors.initials: E
authors.lastname: Kalodiki
authors.forename: George
authors.initials: G
authors.lastname: Geroulakos
mesh_terms: D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity; D001810:Blood Volume; D005260:Female; D005268:Femoral Vein / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012501:Saphenous Vein / Q000000981:diagnostic imaging*; D015911:Sclerotherapy; D053828:Stockings, Compression; D018616:Ultrasonography, Doppler, Duplex; D014648:Varicose Veins / Q000000981:diagnostic imaging / Q000628:therapy*; D055815:Young Adult