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.

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 50 mmHg), provided by a novel adjustable Velcro compression wrap, the CircAid JuxtaLite (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 30 mmHg for posterior tibial veins, and at least 40 mmHg for the saphenous trunk. Apart from morphological changes of the compressed veins, we observed extinction of T2w signal at compression above 40 mmHg, 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 >= 40 mmHg accelerates blood flow in affected deep veins, thus it may facilitate post-thrombotic syndrome management.