Graduated Elastic Compression Stocking Therapy
DESCRIPTION
Compression stockings provide gradient compression for the treatment of venous and lymphatic disease. Compression stockings work by relieving stress on vein walls, restoring venous hemodynamics (aiding muscle pump function and decreasing reflux), and increasing tissue pressures (which leads to decreasing edema). Stockings are rated in mmHg at ankle level and gradually decrease in pressure as they go up the leg.
POLICY
Compression stockings for the treatment of venous and lymphatic diseases are considered medically necessary if the medical appropriateness criteria are met. (See Medical Appropriateness below.)
MEDICAL APPROPRIATENESS
Compression stockings for the treatment of venous and lymphatic disease are considered medically appropriate if ALL the following criteria are met:
ABSENCE of the following contraindications, including, but are not limited to, ALL the following criteria:
Severe peripheral arterial disease
Decompensated congestive heart failure
Septic phlebitis
Phlegmasia cerulea dolens (almost total venous thrombosis of a leg)
ANY ONE of the following:
Varicose veins (all types)
Chronic venous insufficiency
Venous stasis disease
Venous valvular insufficiency
Venous insufficiency
Post thrombotic syndrome
Venous ulcer (stasis ulcer), including ANY ONE of the following:
Edema
Venous
Lymph
Post traumatic
Post surgical
Lipedema
Angiodysplasia
Post sclerotherapy
Thrombosis prevention
Venous eczema
Lipodermatosclerosis
ADDITIONAL INFORMATION
Four pairs of elastic compression stockings are sufficient for a 12-month period of time.
SOURCES
Amaragiri SV, Lees TA. Elastic compression stockings for prevention of deep vein thrombosis (Cochrane Review). In: The Cochrane Library, Issue 1, 2002. Oxford: Update Software. (28 articles and/or guidelines reviewed)
Brandjes, D. P., Buller, H. R., Heijboer, H., Huisman, M. V., de Rijk, M., Jagt, H. & ten Cate, J. W. (1997). Randomised trial of effect of compression stockings in patients with symptomatic proximal-vein thrombosis. Lancet, 349 (9054), 759-762. Abstract retrieved April 9, 2002 from PubMed database.
Choucair, M., & Phillips, T. J. (1998). Compression therapy. Dermatological Surgery, 24 (1), 141-148. Abstract retrieved November 24, 1998 from PubMed database.
Cullum N, Nelson EA, Fletcher AW, Sheldon TA. Compression for venous leg ulcers (Cochrane Review). In: The Cochrane Library, Issue 1, 2002. Oxford: Update Software. (57 articles and/or guidelines reviewed)
Hui, A. C., Heras-Palou, C., Dunn, I., Triffitt, P. D., Crozier, A., Imeson, J., & Gregg, P. J. (1996). Graded compression stockings for prevention of deep-vein thrombosis after hip and knee replacement. Journal of Bone and Joint Surgery, British Volume, 78 (4), 550-554. Abstract retrieved October 30, 1998 from PubMed database.
National Guideline Clearinghouse. (2000, October). Prevention of deep vein thrombosis and pulmonary embolism. Retrieved September 19, 2005 from http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=3971&string=Prevention+AND+deep+AND+vein+AND+thrombosis.
Nelson EA, Bell-Syer SEM, Cullum NA. Compression for preventing recurrence of venous ulcers (Cochrane Review). In: The Cochrane Library, Issue 1, 2002. Oxford: Update Software. (24 articles and/or guidelines reviewed)
Neumann, H. A. (1998). Compression therapy with medical elastic stockings for venous diseases. Dermatological Surgery, 24 (7), 765-770.
Scholten, P., Bever, A., Turner, K., & Warburton, L. (2000). Graduated elastic compression stockings on a stroke unit: A feasibility study. Age and Aging, 29 (4), 357-359. Abstract retrieved April 9, 2002 from PubMed database.
Veraart, J. C., Daamen, E., de Vet, H. C., & Neumann, H. A. (1997). Elastic compression stockings: Durability of pressure in daily practice. VASA, 26 (4), 282-286. Abstract retrieved November 9, 1998 from PubMed database.
World Wide Wounds. (2002, September). Compression hosiery in the prevention and treatment of venous leg ulcers. Retrieved September 20, 2005 from http://www.worldwidewounds.com/2002/september/Johnson/Compression-Hosiery-Leg-Ulcers.html. (27 articles and/or guidelines reviewed)
ORIGINAL EFFECTIVE DATE: 2/8/1999
MOST RECENT REVIEW DATE: 10/9/2008
ID_BT
Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
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