Which pressure of adjustable compression wrap system is necessary to reduce deep vein cross section area in post-thrombotic patients? A proof-of-concept study

Cezary Szary1, Justyna Wilczko1, Tomasz Grzela1,2 and Hugo Partsch3. Phlebolgy 2019.


Objective: The conservative treatment of post-thrombotic syndrome includes application of compression on the affected extremity. However, the type and the level of compression required to manage post-thrombotic syndrome are still unclear. The aim of our proof-of-concept study was to assess the compression required to reduce cross section area of post-thrombotic deep veins in 22 patients with post-thrombotic syndrome.

Methods: The circumference and cross section area of posterior tibial veins and saphenous vein trunk were assessed on mid-calf level using 3T magnetic resonance scanner, at increasing compression (0, 30, 40, and 50mmHg), provided by a novel adjustable Velcro compression wrap, the CircAid JuxtaLiteV R .

Results: A significant reduction of baseline vein cross section area in post-thrombotic syndrome patients in the lying position required compression of at least 30mmHg for posterior tibial veins, and at least 40mmHg for the saphenous trunk. Apart from morphological changes of the compressed veins, we observed extinction of T2w signal at compression above 40mmHg, which corresponded to accelerated blood flow in the veins, and therefore may be considered as a hemodynamic marker of compression effectiveness.

Conclusion: CircAid adjusted to compression level 40mmHg accelerates blood flow in affected deep veins, thus it may facilitate post-thrombotic syndrome management.

Main findings

  • The clinical manifestation of post-thrombotic syndrome (PTS) includes chronic edema, impaired skin perfusion, hemosiderin accumulation, and, finally, development of venous leg ulcer. These signs result from irreversible vein damage after thrombosis with chronic obstruction, fibrosis, and valvular destruction in the affected vein, leading to increased vascular resistance, reflux, and venous hypertension with some dilatation of veins located mainly in the lower leg.
  • The study involved 22 adults (mean age 54.7>13.9 years, including 18 males and 4 females) with postthrombotic changes involving distal femoral, popliteal, or calf deep veins, with patency of saphenous vein trunk, with ankle/brachial pressure index (ABPI) >0.8.
  • Prior to MRI examination, patients were advised to wear CircAid JuxtaLite System (Medi GmbH, Bayreuth, Germany) daily, at least for two weeks, with compression adjusted to 30mmHg, in order to familiarize them with the device.
  • After the first scan, the wraps were applied with increasing compression levels, 30, 40, and 50mmHg, respectively, verified by PicoPress measuring transducer (MICROLAB Elettronica, Italy). Coronal scans of the calf and axial scans of mid-calf (at C point) were acquired with high-resolution T2w images. Our evaluation focused on the morphological changes of the deep posterior tibial veins (PTV) and the superficial great saphenous vein (GSV) by measuring their diameters, circumferences, and mean cross-section areas.
  • The pressure required for T2 signal extinction in the GSV trunk was considered as an indicator of compression effectiveness for superficial veins.
  • This study shows that only a high resting pressure of 40–50mmHg is able to reduce the vein caliber to a degree, for which a reduction of venous refluxes may be expected also in the upright position when the pressure of the inelastic wrapping material will further increase considerably. This pressure range corresponds to values which are produced by first time appliers of adjustable compression wraps, to whom it is explained that they should apply the system very tightly, without causing pain.
  • In the acute phase of DVT, the large individualised versus standard duration of elastic compression therapy for prevention of post-thrombotic syndrome (IDEAL) study has convincingly shown that strong compression using inelastic material does not only reduce pain and leg swelling but also reduces the incidence of residual venous occlusions and of PTS after several months. It was demonstrated that such compression and mobilization applied already in the acute stage of DVT were able to significantly reduce the incidence of PTS. Randomized controlled trials to investigate the potential role of adjustable compression wraps in acute DVT have been initiated.