What is the recommended compression pressure for different clinical indications?

Abstract

Introduction

Compression pressure is the key factor determining effectiveness in compression therapy for venous and lymphatic disorders. Despite its clinical importance, few studies report the actual applied pressure, and national standards for compression classes differ. This review aims to identify the optimal compression pressure at different stages of venous disease.

Methods

A literature search was conducted in PubMed, Scopus, and Web of Science (January 1980–October 2025) using MeSH terms related to compression therapy and chronic venous disease, edema, thrombosis, post-thrombotic syndrome, lipedema, and lymphedema. Only English-language studies reporting compression pressure or class were included.

Results

Low pressures (10–21 mmHg) are enough to relieve symptoms in CEAP C0s–C1. For uncomplicated varicose veins (C2), 18–32 mmHg offers optimal symptom control. In venous edema (C3), pressures of 15–21 mmHg help prevent edema, while around 40 mmHg is more effective for treatment. Lipodermatosclerosis (C4) requires about 40 mmHg, and healed ulcers (C5) benefit from pressures greater than 30 mmHg to prevent recurrence, although compliance decreases with higher pressures. Active ulcers (C6) heal fastest under 40–50 mmHg, preferably with short-stretch materials or adjustable wraps. For lymphedema, effective reduction occurs at more than 50 mmHg (up to 120 mmHg briefly), while in the maintenance phase, 23–32 mmHg with flat-knit garments may be enough. Data on thrombosis, post-thrombotic syndrome, and post-procedure compression remain inconsistent.

Conclusions

Optimal compression pressure depends on disease severity. Early CVD stages and lipedema benefit from a compression pressure <30 mmHg, while severe venous or lymphatic disease requires ≥40 mmHg. Standardized reporting and pressure-based recommendations are essential to improve therapeutic consistency and patient outcomes.