Recommended Compression Levels for Venous Therapy
For venous therapy, compression levels of 20-40 mm Hg are recommended, with 20-30 mm Hg for mild to moderate disease and 30-40 mm Hg for more severe disease. 1
Compression Level Guidelines
- A minimum pressure of 20-30 mm Hg is recommended for basic compression therapy in chronic venous disease 1
- Higher pressures of 30-40 mm Hg are advised for more severe venous disease manifestations 1
- For patients with venous leg ulcers (VLU), inelastic compression of 30-40 mm Hg has been shown to be more effective than elastic bandaging for wound healing 1
- For patients with ankle-brachial indices between 0.9 and 0.6, reduced compression to 20-30 mm Hg is successful and safe for venous leg ulcer healing 1
Compression Application Techniques
- Negative graduated compression bandages (higher pressure at calf than ankle) achieve improved ejection fraction in refluxing vessels compared to traditional graduated compression 1
- Placing compression bandages over the calf rather than just the distal leg provides better pressure distribution and improved ejection fraction 1
- Velcro inelastic compression systems have been shown to be as effective as 3- or 4-layer inelastic bandages for venous ulcer treatment 1
Special Considerations
- Caution is advised when the ankle-brachial index is <0.6, as this indicates arterial disease requiring revascularization before aggressive compression therapy 1
- Compression with eccentric pads placed directly over treated veins (>20 mm Hg) provides the greatest reduction in postoperative pain following ablation or surgical procedures 2
- For mixed arterial and venous ulcers, compression should be limited to patients with ankle-brachial index exceeding 0.5 or absolute ankle pressure >60 mm Hg 2
Compression Duration and Efficacy
- While compression therapy is widely recommended, there is limited evidence regarding optimal duration of compression therapy after procedures 2
- Despite limited evidence for C2-C4 disease (varicose veins, edema, skin changes), there is stronger evidence that compression therapy has value in C5 (healed ulcers) and C6 (active ulcers) disease 1
- Treatment failure often results from non-compliance, so proper fitting, education, and detailed instructions should be emphasized to improve adherence 1
Research Evidence on Compression Levels
- Studies have demonstrated that compression stockings exerting approximately 20 mm Hg on the distal leg can increase venous blood flow velocity in the supine position and prevent leg swelling after prolonged sitting and standing 3
- In the upright position, an interface pressure of more than 50 mm Hg is needed for intermittent occlusion of incompetent veins and for reduction of ambulatory venous hypertension during walking 3
- High intermittent interface pressure peaks that provide a "massaging effect" are better achieved by short-stretch multilayer bandages than by elastic stockings 3
Compression therapy remains a cornerstone in the management of venous and lymphatic insufficiency, with clear evidence supporting specific pressure ranges for different clinical scenarios 3, 4.