Partsch, H., Flour, M., Smith, P.C., & International Compression Club. (2008). Indications for compression therapy in venous and lymphatic disease consensus based on experimental data and scientific evidence. Under the auspices of the IUP. International Angiology, 27(3), 193–219.

To review published literature concerning the use of compression treatments in the management of venous and lymphatic diseases and establish where reliable evidence exists to justify the use of medical compression and where further research is required to address areas of uncertainty

The authors searched medical literature databases and reviewed their own collections of papers, monographs, and books for papers providing information about the effects of compression and randomized clinical trials of compression devices. Studies were included in the review if they used compression stockings, bandages, and intermittent pneumatic compression devices. Exclusion criteria were not specified.

The International Compression Club (ICC) reviewed and to commented critically on published literature on compression therapy concentrating on two issues: (a) experimental findings concerning clinically relevant effects of compression therapy and (b) randomized clinical trials (RCTs) addressing the use of compression for particular clinical indications. The findings were presented by several members of the group and discussed at a meeting of the ICC, held in May 2007 in Vienna, Austria. The assessment of the strength of the recommendations from randomized trials was based on the scoring criteria from the international Grading of Recommendations Assessment, Development, and Evaluation (GRADE) group. Thereafter, the data were summarized in tables that were circulated among the members of the ICC by email. The corrected version of these tables was agreed upon by a majority of the active participants at a follow-up ICC meeting, held in November 2007 in Paris.

The number of studies included in the report, total sample size, sample range across studies, and sample characteristics were not mentioned.

A wide range of compression levels was reported to be effective. Low levels of compression 10–30 mm Hg applied by stockings are effective in the management of telangiectases after sclerotherapy, varicose veins in pregnancy, the prevention of edema, and deep vein thrombosis (DVT). High levels of compression produced by bandaging and strong compression stockings (30–40 mmHg) are effective at healing leg ulcers and preventing progression of post-thrombotic syndrome as well as in the management of lymphedema. In some areas no reliable evidence was available to permit recommendations of level of compression or duration of treatment. These included management of varicose veins to prevent progression following surgical treatment or sclerotherapy for varicose veins and the level of compression required to treat acute DVT.

The review shows that while good evidence for the use of compression is available in some clinical indications, there is much still to be discovered. Little is known about dosimetry in compression or for how long and at what level compression should be applied. The differing effects of elastic and short-stretch compression are also little understood.