Comparative Efficacy of Knee-High Versus Thigh- High Compression Stockings in Managing Chronic Venous Insufficiency: A Retrospective Comparative Cohort Study

Abstract

Objective To compare the clinical efficacy and patient adherence of knee-high versus thigh-high compression stockings, each combined with calcium dobesilate, versus pharmacologic therapy alone in the conservative management of chronic venous insufficiency (CVI). Material and Method This retrospective comparative cohort included 85 screened and 77 analyzed adults with duplex ultrasound– confirmed CVI (CEAP C1–C5) treated at a single tertiary center (January–June 2023). Patients received: (Group 1) knee-high stockings (European Class II, 23–32 mmHg) + calcium dobesilate 500 mg bid; (Group 2) thigh-high stockings (Class II) + dobesilate; or (Group 3) dobesilate alone. Each compression patient was provided two pairs and instructed for daily wear for≥3 months. Adherence (≥80% of prescribed days/doses) was assessed via diaries, monthly calls, in-clinic inspection (compression), and pill counts/ self-report (drug). Disease severity was evaluated by Venous Clinical Severity Score (VCSS) at 3 and 6 months. Non-parametric tests with effect sizes were used. Results Among 77 analyzed patients, Group 1 (knee-high + dobesilate) achieved the greatest improvement, with median VCSS decreasing from 8.5 (IQR 7–10) to 4.9 (IQR 4–6) at 6 months (p < 0.01, r = 0.63). Group 2 (thigh-high + dobesilate) improved modestly (8.7 → 6.9; p < 0.05, r = 0.42) while Group 3 (dobesilate alone) showed no significant change (8.3 → 7.7; p > 0.05). Patient-reported symptomatic relief occurred in 87.1%, 34.8%, and 34.8% of Groups 1–3, respectively (φ = 0.55, p < 0.001). Compression adherence was ~90% for knee-high, ~22% for thigh-high users, and pharmacologic adherence exceeded 85% in all groups. No major adverse events or discontinuations occurred. Conclusion Knee-high stockings plus calcium dobesilate yielded superior clinical improvement and adherence versus thigh-high stockings or pharmacologic therapy alone. Comfort and usability were key adherence drivers; knee-high Class II compression should be prioritized in most CVI patients, with pharmacologic therapy as a useful adjunct, particularly in early stages.

Keywords

• Chronic venous insufficiency
• Compression therapy
• Knee-high stockings
• Thigh-high stockings
• Patient adherence
• Venous Clinical Severity Score

Supporting Institution

This research did not receive any specific grant from funding agencies in the public, commercial, or not-forprofit sectors.

Project Number

N/A

Ethical Statement

This retrospective study was approved by the Institutional Ethics Committee (Approval No: 2023/09/02/045; September 2023). Owing to the retrospective design and the use of anonymized data, the requirement for informed consent was waived. The study was conducted in accordance with the principles of the Declaration of Helsinki (2013 revision).

Thanks

The authors thank the outpatient nursing staff and vascular laboratory technologists of the cardiovascular center for their assistance with patient follow-up and duplex ultrasound assessments.

References

1. 1. Mayrovitz HN, Aoki KC, Colon J. Chronic Venous Insufficiency With Emphasis on the Geriatric Population. Cureus. 2023 Jun 20;15(6):e40687. doi: 10.7759/cureus.40687.
2. 2. Labropoulos N, Tiongson J, Pryor L, et al. Definition of venous reflux in lower-extremity veins. J Vasc Surg. 2003;38(4):793– 798. doi:10.1016/s0741-5214(03)00424-5.
3. 3. Konschake W, Riebe H, Pediaditi P, et al. Compression in the treatment of chronic venous insufficiency: efficacy depending on the length of the stocking. Clin Hemorheol Microcirc. 2016;64(3):425–434. doi:10.3233/CH-168122.
4. 4. Uhl JF, Benigni JP, Chahim M, Fréderic D. Prospective randomized controlled study of patient compliance in using a compression stocking: Importance of recommendations of the practitioner as a factor for better compliance. Phlebology. 2018 Feb;33(1):36- 43. doi: 10.1177/0268355516682886. Epub 2016 Dec 9.
5. 5. Rabe E, Jaeger KA, Bulitta M, Pannier F. Calcium dobesilate in patients suffering from chronic venous insufficiency: a double-blind, placebo-controlled, clinical trial. Phlebology. 2011 Jun;26(4):162-8. doi: 10.1258/phleb.2010.010051. Epub 2011 Apr 7.
6. 6. Rabe E, Partsch H, Hafner J, et al. Indications for medical compression stockings in venous and lymphatic disorders: An evidence-based consensus statement. Phlebology. 2018;33(3):163–184. doi:10.1177/0268355516689631.
7. 7. Benigni JP, Branchoux S, Bacle I, Taieb C. Difficulty associated with donning medical compression stockings: results from a survey comparing two different compression stockings. Womens Health (Lond). 2013;9(3):291–300. doi:10.2217/ whe.13.13.
8. 8. Buset CS, Fleischer J, Kluge R, et al. Compression stocking with 100% donning and doffing success: an open-label randomised controlled trial. Eur J Vasc Endovasc Surg. 2021;61(1):137–144. doi:10.1016/j.ejvs.2020.09.027.

9. 9. Clarke-Moloney M, Keane N, O'Connor V, et al. Randomised controlled trial comparing European standard class 1 to class 2 compression stockings for ulcer recurrence and patient compliance. Int Wound J. 2014;11(4):404–408. doi:10.1111/j.1742- 481X.2012.01108.x.
10. 10. Arslanturk O, Uymaz B, Gumus F. Which dose of calcium dobesilate is more effective and safe in chronic venous insufficiency? Multicenter retrospective clinical trial. Phlebology. 2025 Apr;40(3):167-173. doi: 10.1177/02683555241286367. Epub 2024 Sep 19.
11. 11. Rabe E, Ballarini S, Lehr L; Doxium EDX09/01 Study Group. A randomized, double-blind, placebo-controlled, clinical study on the efficacy and safety of calcium dobesilate in the treatment of chronic venous insufficiency. Phlebology. 2016 May;31(4):264- 74. doi: 10.1177/0268355515586097. Epub 2015 May 18.
12. 12. Perrin M, Eklöf B. Does prescription of medical compression prevent development of post-thrombotic syndrome after proximal deep venous thrombosis? Phlebology. 2016;31(3):160– 169. doi:10.1177/0268355515585437.
13. 13. de Moraes Silva MA, Nelson A, Bell-Syer SE, Jesus-Silva SG, Miranda F Jr. Compression for preventing recurrence of venous ulcers. Cochrane Database Syst Rev. 2024 Mar 7;3(3): CD002303. doi: 10.1002/14651858.CD002303.pub4.
14. 14. Danielsson G, Eklof B, Grandinetti A, Lurie F, Kistner RL. Deep axial reflux, an important contributor to skin changes or ulcer in chronic venous disease. J Vasc Surg. 2003 Dec;38(6):1336-41. doi: 10.1016/s0741-5214(03)00907-8.
15. 15. Coral FE, Guarinello GG, Cavassola AP, Rocha ALM, Guidi MM, Pires H. Chronic venous insufficiency and graduated compression stockings: analysis of public health system patients' adherence to treatment. J Vasc Bras. 2021 Jun 4;20:e20200034. doi: 10.1590/1677-5449.200034.
16. 16. Nelson EA, Bell-Syer SE, Cullum NA. Compression for preventing recurrence of venous ulcers. Cochrane Database Syst Rev. 2000;(4): CD002303. doi: 10.1002/14651858.CD002303. Update in: Cochrane Database Syst Rev. 2012 Aug 15;(8): CD002303. doi: 10.1002/14651858.CD002303.pub2.
17. 17. Simka M, Majewski E. The social and economic burden of venous leg ulcers: focus on the role of micronized purified flavonoid fraction adjuvant therapy. Am J Clin Dermatol. 2003;4(8):573-81. doi: 10.2165/00128071-200304080-00007.