Compression therapy for occupational leg symptoms and chronic venous disorders - A meta-analysis of randomised controlled trials

Objective. Leg discomfort and oedema are commonly attributed to a venous disorder (CVD) or chronic venous insufficiency (CVI) and treated with compression hosiery. The pressure needed to achieve clinical benefit is a matter of debate. Design. We performed a meta-analysis of randomised controlled trials (RCT) that compared stockings exerting an ankle pressure of 10-20 mmHg with placebo or no treatment and with stockings exerting a pressure of more than 20 mmHg. Methods. RCT were retrieved and analysed with the tools of the Cochrane Collaboration. Each study was reviewed independently. Subjective dichotomous and continuous factors and objective findings were pooled for statistical treatment. Results. Eleven RCT fulfilled the predefined criteria. They included 1453 randomised subjects, 794 healthy people exposed to various forms of stress, 552 patients with a chronic venous disorder or chronic venous insufficiency and 141 patients after varicose vein surgery. Over all, compression with 10-20 mmHg had a clear effect on oedema and symptoms as compared with <10 mmHg pressure, placebo stockings, or no treatment (p < .0001). No study showed a difference between 10-20 and >20 mmHg stockings. Conclusions. Despite important methodological heterogeneity and sometimes sub-standard reporting the meta-analysis suggests that leg compression with 10-15 mmHg is an effective treatment for CVD. Less pressure is ineffective and higher pressure may be of no additional benefit. (C) 2007 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.