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Important
This article is for reference only and summarizes information from open sources. The information is educational in nature and does not replace consultation with a specialist.

Varicose Veins: What Is This Condition and Why Does It Progress

Varicose vein disease is a chronic venous disorder. The underlying problem is most often venous reflux (backward blood flow) and/or obstruction to outflow, leading to venous stasis and elevated venous pressure in the leg veins during walking (ambulatory venous hypertension). Over time, this creates a “vicious cycle”: vein dilation → poorer valve closure → increased reflux → worsening stasis and symptoms.

Why Varicose Veins Can Worsen:

  • venous stasis sustains changes in the vein wall and valvular apparatus;
  • stasis triggers microcirculatory and inflammatory changes that intensify swelling and tissue manifestations;
  • aggravating factors (prolonged standing, sedentary work, excess weight, low physical activity) often make symptoms more persistent and severe;
  • clinical guidelines emphasize that varicose veins can progress, and controlling risk factors (weight, activity) is important.

Where Varicose Veins Most Commonly Appear

Varicose veins most commonly develop in the lower extremities — this is by far the most typical and predominant location of the disease. Leg veins (especially the great saphenous vein along the inner thigh and calf, the small saphenous vein on the posterior calf, and their tributaries) are affected in the vast majority of cases — over 95–98% of all clinically significant varicose veins. Other forms (hemorrhoids, pelvic varices, esophageal varices) are less common, but classic “varicose veins” are almost always associated with the legs.

Why the legs? The main reason is gravity combined with the upright posture of humans. During prolonged standing or sitting, blood in the leg veins must overcome a significant height (up to 120–150 cm from feet to heart), creating high hydrostatic pressure. If vein valves are weak or damaged, backward flow (reflux) occurs, leading to venous stasis and stretching of vein walls. This is most pronounced in the calves and feet (medial and posterior calf, ankle area, dorsum of the foot), where pressure is highest and fascial/muscular support is weakest. Varicose changes often start in the feet and lower third of the calf with small dilated veins and swelling, then spread upward.

According to various studies and clinical reviews, varicose changes most frequently localize as follows:

  • calves (especially medial and posterior surfaces) — up to 70–80% of cases;
  • thighs (along the great saphenous vein) — about 40–60%;
  • feet and ankles — often as an early manifestation or combined with swelling.

This localization is determined by anatomy: the most common site of great saphenous vein valve incompetence is below the knee (the most frequent reflux point), as well as perforating veins connecting superficial and deep systems.

In summary, varicose veins in the legs are not random — they are a direct consequence of human bipedalism and a lifestyle dominated by static loads.

What Symptoms May Indicate Developing Varicose Veins

Symptoms of varicose veins in the lower extremities (varicose disease and chronic venous insufficiency) usually develop gradually and often worsen toward the end of the day, after prolonged standing, sitting, heat, or physical exertion. In early stages they may be nonspecific and perceived as ordinary fatigue, but over time become more pronounced and persistent.

The most common complaints reported by patients (based on NICE, ESVS guidelines and numerous reviews):

  • heaviness, fatigue, and aching pain in the legs — one of the earliest and most widespread symptoms (present in most patients with symptomatic varicose veins); legs feel “lead-weighted,” with discomfort and a desire to lie down or elevate them;
  • sensation of fullness, “buzzing,” or tightness in the calves and feet — as if the legs are “pressing from the inside”;
  • swelling (especially around ankles, calves, and feet) — appears or worsens in the evening, decreases after overnight rest or leg elevation; in later stages swelling may become permanent;
  • nocturnal calf muscle cramps — a frequent sign of venous stasis, especially when lying down;
  • itching, burning, tingling, or “pins and needles” on calf skin — caused by tissue irritation and microcirculatory disturbances;
  • pain or discomfort along the veins — aching, pulling, or throbbing pain that worsens with load.

Less commonly but still characteristic: restless legs, increased fatigue when walking, visible skin changes (dryness, hyperpigmentation, spider veins or reticular veins as early signs). Important: not all symptoms need to be present at once, and their severity does not always match vein size — even small varicose changes can cause significant discomfort.

Role of Pneumatic Compression Therapy in Varicose Veins

Pneumatic compression therapy (intermittent pneumatic compression, IPC) is an effective and modern method of compression support for varicose vein disease and chronic venous insufficiency. It is used to improve venous outflow, reduce blood and lymph stasis, relieve symptoms, and prevent disease progression. The sequential “wave” of pressure from foot upward mimics the muscle pump, helping unload veins, reduce swelling, and restore lightness to the legs — especially noticeable after long standing, sedentary work, flights, or intense days.

Pneumatic compression therapy is particularly effective in the following situations:

  • pronounced evening heaviness, fullness, and leg swelling;
  • rapid recovery after high venous load;
  • venous edema and lymphovenous insufficiency;
  • home use for regular support (sessions 30–60 minutes, 3–5 times per week);
  • as a comfortable alternative or supplement to compression stockings when daily donning is difficult (elderly patients, overweight, limited mobility).

Clinical data confirm that regular IPC use leads to reduced pain, swelling, improved blood flow, and quality of life — patients notice significant relief already after the first courses. The method is well tolerated, non-invasive, and allows individual adjustment of pressure and modes (usually 40–60 mm Hg with gradient).

Why Pneumatic Compression Therapy Helps with Varicose Veins

Pneumatic compression therapy (intermittent pneumatic compression, IPC) helps with varicose veins due to its effective and physiological mechanism of action, which mimics the natural work of the leg muscle pump. The device uses multi-chamber cuffs that sequentially inflate from foot upward (gradient sequential compression), creating a “wave” of pressure: first compressing the foot and ankle, then calf, thigh. This leads to several key effects:

  • acceleration of venous outflow: external pressure compresses superficial and deep veins, pushing stagnant blood toward the heart and significantly increasing venous flow velocity (according to studies — up to 2–3 times compared to rest);
  • reduction of venous stasis and hydrostatic pressure: rhythmic “compression–pause” cycles prevent blood pooling in dilated veins, reduce reflux and venous hypertension — the main causes of heaviness, fullness, and swelling;
  • improvement of lymphatic drainage: pressure helps remove excess tissue fluid, which is especially important in venous edema, reducing leg volume and the feeling of “fullness”;
  • stimulation of endothelium and anti-inflammatory effect: mechanical action creates shear stress on vessel walls, stimulating nitric oxide (NO) release, improving endothelial function, increasing fibrinolysis, and reducing local inflammation in the vein wall.

Application of Pneumatic Compression Therapy for Varicose Veins in Clinical Practice

Example 1 (varicose veins, 6-week course)

randomized controlled trial in women with varicose veins. 28 participants, control and experimental groups. The experimental group used sequential pneumatic compression (SPC) together with regular lower limb exercises. Improvements in pain, venous flow parameters, and quality-of-life scores were described compared to control.

Source (PMC): https://pmc.ncbi.nlm.nih.gov/articles/PMC4968489/
PubMed: https://pubmed.ncbi.nlm.nih.gov/27512247/

Example 2 (standing work, swelling and pain “after shift”)

study in people with prolonged standing work. 39 participants, crossover design comparing different recovery methods, including IPC. Reported reduction in pain and calf/ankle circumferences (as edema markers) with IPC; the publication noted no adverse events during the study.

PubMed: https://pubmed.ncbi.nlm.nih.gov/34260560/
PMC: https://pmc.ncbi.nlm.nih.gov/articles/PMC8284752/

Example 3 (home use, leg swelling)

pilot randomized controlled trial of home IPC in patients with lower limb edema and reduced mobility. 50 patients (IPC group n=29, control n=21), duration 1 month. Described reduction in swelling and improvement in several clinical/functional parameters and quality of life.

Source (ScienceDirect): https://www.sciencedirect.com/science/article/pii/S2213333X18301306
PubMed: https://pubmed.ncbi.nlm.nih.gov/29909855/

Example 4 (patient-centered outcomes in chronic venous disease)

multicenter randomized study comparing a pneumatic compression device with compression stockings in patients with chronic venous disease. 89 patients (136 limbs). Key emphasis — not only measurements but also comfort/tolerability and actual willingness to use the method.

Full text: https://www.jvsvenous.org/article/S2213-333X(17)30266-4/fulltext
PubMed: https://pubmed.ncbi.nlm.nih.gov/28818225/

Safety of Pneumatic Compression Therapy for Varicose Veins

Pneumatic compression therapy is considered one of the safest and gentlest methods of compression support for varicose vein disease and chronic venous insufficiency. It is a completely non-invasive procedure without punctures, injections, or drug load — action is provided solely by externally regulated air pressure in cuffs. When used correctly (individually selected pressure 40–60 mm Hg, gradient from foot upward, no pain or numbness during the session), complications occur extremely rarely according to international consensus and reviews.

Most patients tolerate the procedure well: it feels like a pleasant rhythmic massage that quickly brings relief. Possible mild and transient sensations include warmth, light tingling, sweating under cuffs, or movement restriction during the session — these effects disappear immediately after the procedure. Rarely noted are skin irritation, discomfort, or small bruises/petechiae from excessively high pressure or improper cuff fitting, but these are easily corrected by adjusting the device.

The method is safe for home use when following recommendations: start with comfortable modes, do not exceed 60–90 minutes per session, monitor skin condition. Clinical studies and guidelines (including ESVS 2022 and subsequent updates) confirm good tolerability of IPC even with long-term use in patients with venous edema, post-thrombotic syndrome, or after loads.

However, in varicose veins there are several important contraindications for pneumatic compression therapy related specifically to the condition of the lower limb veins. The procedure must not be performed in cases of:

  • acute deep or superficial vein thrombosis, suspicion of thrombosis (sudden pain, asymmetric swelling, redness, heat);
  • active thrombophlebitis or phlebitis;
  • severe arterial insufficiency of the legs (ABI < 0.6–0.8, marked ischemia);
  • unhealed wounds, purulent or inflammatory skin processes in the cuff area.

Conclusion

Pneumatic compression therapy is a convenient, pleasant, and scientifically grounded way to care for your veins: it helps control key manifestations of varicose veins (stasis, swelling, inflammatory changes), slow disease progression, and maintain an active lifestyle without discomfort.

Pneumatic compression not only quickly relieves symptoms (legs feel lighter, pain, swelling, and fatigue decrease), but also helps break the “vicious cycle” of varicose vein progression: less stasis → less valve and vein wall damage → slower development of complications. The effect is felt already after the first sessions, and with regular use it accumulates, supporting vein health and your active lifestyle.

Source: gesberg.eu

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