Compression Therapy Guidelines for Venous Disease

Compression Level Recommendations

The American College of Radiology recommends compression levels of 20-40 mm Hg for venous therapy, with 20-30 mm Hg for mild to moderate disease and 30-40 mm Hg for more severe disease 1, 2
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, 2
For patients with venous leg ulcers, 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

Negative graduated compression bandages 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

Caution is advised when the ankle-brachial index is <0.6, as this indicates arterial disease requiring revascularization before aggressive compression therapy 1

Despite limited evidence for C2-C4 disease, there is stronger evidence that compression therapy has value in C5 and C6 disease 1
Treatment failure often results from non-compliance, so proper fitting, education, and detailed instructions should be emphasized to improve adherence 1