Mobile patients with acute proximal DVT treated with low molecular weight heparin should be encouraged to walk with compression bandages or medical compression stockings. The rate of resolution of pain and swelling is significantly faster when the patient ambulates with compression. The risk of pulmonary embolism is not significantly increased by this approach.

Leg compression with stockings is clearly better than compression with bandages, has a positive impact on pain, and is easier to use.

WHAT THIS PAPER ADDS? Measuring great saphenous vein (GSV) diameter is standard in pre-interventional assessment of varicose disorders, but has never been properly validated. This work assessed the relative value of measuring GSV diameter at the most often used sites: the sapheno-femoral junction and the proximal thigh. We found a better correlation of the latter with reflux and both higher sensitivity and specificity for clinical disease severity. A conversion factor was calculated and used to revise published data. The conversion factor enabled comparison of venous disease severity of patients included in 10 interventional series with preoperative GSV measurements taken either at the sapheno-femoral junction or at the proximal thigh. Background: Great saphenous vein (GSV) incompetence is involved in the majority of cases of varicose disease. Standardised pre-interventional assessment is required to analyse the relative merit of treatment modalities. We weighed GSV diameter measurement at the sapheno-femoral junction (SFJ) against measurement at the proximal thigh 15 cm distal to the groin (PT), established a conversion factor and applied it to selected literature data. Methods: Legs with untreated isolated GSV reflux and varices limited to its territory and control legs were studied clinically, with duplex ultrasound and photoplethysmography. GSV diameters were measured at both the SFJ and the PT. A conversion factor was calculated and used to compare published data. Results: Of 182 legs, 60 had no GSV reflux (controls; group I), 51 had above-knee GSV reflux only (group II) and 71 had GSV reflux above and below knee (group III). GSV diameters in group I measured 7.5 mm (AE1.8) at the SFJ and 3.7 mm (AE0.9) at the PT. In groups II and III, they measured 10.9 mm (AE3.9) at the SFJ and 6.3 mm (AE1.9) at the PT (p < 0.001 each). Measurement at the PT revealed higher sensitivity and specificity to predict reflux and clinical class. Good correlation between sites of measurement (r ¼ 0.77) allowed a conversion factor (SFJ ¼ 1.767 * PT, PT ¼ 0.566*SFJ) to be applied to pre-interventional data of published studies. Conclusions: GSV diameter correlates with clinical class, measurement at the PT being more sensitive and more specific than measurement at the SFJ. Applying the conversion factor to published data suggests that some studies included patients with minor disease.