Place and role of compression therapy in modern minimally invasive treatment of varicose veins

Chronic venous disease (CVD), which includes varicose veins (VVs) of the lower limbs, is one of the most common and socially significant cardiovascular diseases. Despite the recognition of elastic compression as an essential method of CVD treatment, the benefits and feasibility of its usage during the perioperative period are being reconsidered. This narrative literature review aims to highlight the current evidence of the efficacy of elastic compression in relieving initial and residual vein-specific symptoms, reducing the risk of adverse events and VVs recurrence after surgical treatment. It also provides brief information about the mechanisms of action of compression therapy and discusses compliance issues. Nowadays, the concept of the influence of elastic compression on the diameter of veins and venous outflow velocity has been critically revised. It has been shown that deep veins are more sensitive to external compression, while it is impossible to reduce the caliber of superficial veins under the usual pressure. Extensive evidence indicates the efficacy of compression therapy in relieving venous symptoms, which may persist in 30—40% of patients after surgery. The usage of compression therapy perioperatively helps reduce the rate and severity of such adverse events as pain, bruising, and hyperpigmentation, as well as promotes the resorption of veins after sclerotherapy. However, the optimal mode and duration of compression have not been finally determined. Despite the presence of individual studies, the effect of compression therapy on the progression of CVD and the risk of VVs recurrence has not been proven. The main disadvantage of elastic compression is relatively low compliance, which varies between 26 and 74%. To improve it, both motivational conversations by the doctor and efforts by manufacturers to maintain maximal product quality while giving them optimal properties for comfortable wear are essential. Thus, compression therapy is still an important component of the perioperative treatment of VVs of the lower limb.