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Anti-Embolic Stockings

AES are designed to exert sustained graduated compression to the legs decreasing from the ankle towards the knee and thigh. This mechanical support to the leg decreases the cross-sectional profile of the vein, which increases venous velocity 1 (Autar 2009).

AES also prevent the pathological progression of passive venous distension to the point where sub-endothelial tears and activation of clotting factors might occur 2,3 .

In 1975 Sigel 4 identified an optimal stocking compression profile ranging from 18mmHg compression at the ankle to 8mmHg compression at the mid-thigh. Commonly known as the Sigel profile, this is the standard against which all AES performance is compared 1.

Despite the apparent simplicity as a modality, AES are heterogeneous with respect to length, compression profile and fit. To ensure therapeutic benefit and prevent complications (such as reverse pressure gradients and skin breakdown), a number of conditions must be satisfied including assessment and appropriate fitting using standardised protocols for measurement and application by trained staff 5,6 .

Poorly fitted stockings or those of an incorrect shape and size also have the potential to cause a tourniquet effect on the proximal part of the limb where the stocking is applied. This can result in ischaemia and an increased risk of thrombosis development 2.

AES should be worn immediately a risk is identified until a normal level of physical activity is resumed. Leg measurement should be reviewed regularly; if AES are too loose they will be ineffective and if they are too tight they may compromise vascular supply 7.

The choice between knee-high and thigh-length AES should be based upon clinical judgement, patient preference, concordance and surgical site, given the lack of evidence that any one type has superior efficacy 8.

Please click here to download our DVT Clinical Evidence Brochure

 

 Autar R. A review of the evidence for the efficacy of anti-embolism stockings (AES) in venous thromboembolism prevention. Journal of Orthopaedic Nursing. 2009; 13: 41-49.
2 Morris RJ & Woodcock JP. Evidence based compression. Prevention of stasis and deep vein thrombosis. Annals of Surgery. 2004; 239(2): 162-171
3 Benko T, Cooke EA, McNaly MA, Mollan RA. Graduated compression stockings: knee length or thigh length. Clinical Orthopaedics and Related Research. 2001; 383: 197-203.
4 Sigel B, Edelstein A, Savitch L et al. Type of compression for reducing venous stasis . A study of lower extremities during inactive recumbency. Archives of Surgery. 1975; 110: 171-175.
5 Best AJ, Williams S, Crozier A et al. Graded compression stockings in elective orthopaedic surgery: An assessment of the in vivo performance of commercially available stockings in patients having hip and knee arthroplasty. The Journal of Bone and Joint Surgery – British Volume. 2000; 82: 116-118.
6 Walker L, Lamont S. The use of anti-embolic stockings. Part 1: a literature review. British Journal of Nursing. 2007; 16(22): 1408-1412.
7 Agu O, Hamilton G and Baker D. Graduated compression stockings in the prevention of venous thromboembolism. British Journal of Surgery. 1999; 86(8): 992-1004.
8 National Institute for Health and Clinical Excellence. Venous thromboembolism: reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients admitted to hospital. 2010 At: www.nice.org.uk/guidance/CG92

 

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