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Volume control of the lower limb with graduated compression during different muscle pump activation conditions and the relation to limb circumference variation.

  • Gianesini, Sergio1
  • Raffetto, Joseph D2
  • Mosti, Giovanni3
  • Maietti, Elisa4
  • Sibilla, Maria Grazia5
  • Zamboni, Paolo5
  • Menegatti, Erica5
  • 1 Vascular Diseases Center, Translational Surgery Unit, University of Ferrara, Ferrara, Italy; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Md. Electronic address: [email protected] , (Italy)
  • 2 Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Md; Harvard Medical School, VA Boston Healthcare System, Brigham and Women's Hospital, Boston, Mass.
  • 3 Angiology Department, Clinica MD Barbantini, Lucca, Italy. , (Italy)
  • 4 Center for Clinical Epidemiology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy. , (Italy)
  • 5 Vascular Diseases Center, Translational Surgery Unit, University of Ferrara, Ferrara, Italy. , (Italy)
Published Article
Journal of vascular surgery. Venous and lymphatic disorders
Publication Date
Sep 01, 2020
DOI: 10.1016/j.jvsv.2019.12.073
PMID: 32089499


The literature supports the use of graduated compression stockings (GCS) for leg edema. Nevertheless, there is a paucity of data on the GCS effect on limb edema related to sitting, standing, and walking. Data of different limb shapes and their impact on GCS-exerted pressure are lacking. This investigation provides evidence-based information on the effect of GCS on edema reduction and the impact of limb circumference gradients on GCS pressure. Thirty healthy individuals (15 men and 15 women; mean age, 32 ± 5 years) were included. All the participants underwent lower limb volume (Kuhnke formula) measurement, before and after sitting for 30 minutes, wearing below-ankle noncompressive socks. The same assessment was repeated 7 days later, in the same participants, but with wearing of below-knee 16 to 20 mm Hg GCS. At 7-day intervals, 1 week with below-ankle noncompressive socks and 1 week with below-knee 16 to 20 mm Hg GCS, all the participants repeated the same protocol including standing and walking. Ten participants underwent bioimpedance assessment (Biody Xpert II; eBIODY, La Ciotat, France) before and after sitting, standing, and walking. In the same group, B and B1 interface pressure values were measured. Data collection was completed in all 60 limbs. Sitting or walking without GCS led to no significant volume changes, whereas volume was decreased by the use of GCS (-4.8% [P < .00001] and -4.4% [P < .00001], respectively). Standing up without GCS led to an increase in volume (2.7%; P < .0001), whereas limb volume was decreased (4.6%; P < .0001) by use of GCS. Bioimpedance showed extracellular water reduction only while walking with GCS (from 40.55% ± 1.66% to 40.45% ± 1.71%; P < .017). Mean interface pressure was 19 ± 5 mm Hg (B) and 16 ± 5 mm Hg (B1). The interface pressure variation from B to B1 was not homogeneous among participants (mean percentage variation of -13% ± 25%, ranging from -54% to 16%). A negative linear trend between pressure variation and circumference percentage increase was found; the subanalysis excluding the two outliers showed a strong negative linear correlation (Pearson coefficient r = -0.96). GCS led to a significant limb volume reduction irrespective of limb position and muscle pump function. However, extracellular fluid is mobilized only during muscle contraction while walking with GCS. Interestingly, different lower limb circumference variations influence the interface pressure gradient, indicating the importance of proper fitting of both B and B1 during prescription. These data provide a foundation to future investigations dealing with GCS effect on fluid mobilization and with limb geometry impact on compression performance. Copyright © 2020 Society for Vascular Surgery. All rights reserved.

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