Phlebology Article by Dr. David Calcagno & Dr. John Rossi

Phlebology. 2011 Sep;26(6):235-6. doi: 10.1258/phleb.2010.010045. Epub 2011 May 19.

The impact of insurance company mandated compression stocking trial on rate of intervention in patients with symptomatic venous reflux disease.

By Calcagno D, Rossi JA.

Calcagno and Rossi Vein Treatment Center, Mechanicsburg, PA, USA.


Insurance companies have criteria for a venous intervention to be a covered procedure, including symptoms, vein size, and a trial of conservative therapy with compression stockings. The goal of this study was to see the impact of such mandated stocking use on ultimate intervention.


A retrospective review was done of prospectively gathered data entered in the electronic medical record. Two-hundred consecutive new patients evaluated at our vein center were included.


Forty-four of the 200 patients did not require any procedures and 39 patients had procedures scheduled for small or asymptomatic venous changes that did not meet insurance criteria. This left 117 patients with venous symptoms in whom evaluation concluded that a corrective procedure could be performed. These interventions included largely radiofrequency ablation and phlebectomy. Of these 117 patients, 48 had previously used compression stockings. In the remaining 69 patients, stockings were provided on the day of initial consultation and these 69 patients served as the subjects for this review. At three month follow up, one patient reported the stockings help enough that she did not want to pursue correction. Two patients had continued pain and were planning correction once other unrelated issues resolved. Three patients said they never wore the stockings. Sixty-one patients had procedures performed. The average length of stocking use in patients who chose corrective procedures was 103 days. One patient could not be reached.


Of the patients that reported they used the stockings as prescribed, one chose chronic stocking therapy and 63 patients either had procedures or were planning procedures. Use of prescription stockings was effective in avoiding intervention in one of 64 cases (2%), despite an average trial of 103 days. These results cast doubt on the merits of the use of an insurance company mandated stocking trial.

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