Chronic Venous Insufficiency, Thrombophlebitis, and Varicose Veins

Assessment and Plan: Chronic Venous Insufficiency and Varicose Veins

• Daflon, a widely available natural flavonoid agent containing 90% diosmin and 10% hesperidin has had excellent results in treatment of chronic venous insufficiency (CVI):

• In two randomized, double-blind, 2-month studies, Daflon 500 mg twice daily significantly decreased ankle and calf circumferences, discomfort (nocturnal cramps and sensations of leg heaviness, swelling, or heat), and more leg ulcers were healed in patients with chronic venous insufficiency (CVI) compared to placebo or standard care alone (1).

• Compression therapy with either Daflon 500 mg (two tablets daily) or placebo for 8 weeks showed during an 8-week period significantly shorter time to complete healing in the Daflon 500 mg group (32%) compared with placebo (13%)(2).

• Horse chestnut for chronic venous insufficiency (CVI):

• Seven clinical trials and concluded that horse chestnut seed extract was effective for CVI, reduced leg pain and was safe without severe adverse effects vs. placebo including a study reviewed by the author showing it to be as effective as compression stockings (3).

• Another review of 13 randomized controlled trials showed that horse chestnut seed extract compared to placebo reduced leg volume by 46.4 ml, increased the chances of improving leg pain by 4.5 times, edema/swelling by 1.5 times, and itching by 1.7 times without serious side-effects (4).

• Compared to placebo, horse chestnut extract, escin at a dose of 75 mg oral twice daily, significantly reduced edema (5).

• Aescin (contains horse chestnut) combined with essential phospholipids (AEPL) topical gel for chronic venous insufficiency (CVI): Treatment with AEPL in areas of diseased blood vessels improved skin perfusion and appeared to prevent venous ulcerations (6).

• Pycnogenol for chronic venous insufficiency (CVI):

• Swelling (edema), leg ‘heaviness’, and pressure in the veins were significantly reduced in a study with 40 patients after the use of Pycnogenol at a dose of 100 mg, 2-3 times per day for 2 months and no side-effects were reported (7).

• Pycnogenol 100 mg oral 3 times daily or placebo for 3 months showed that 60% of subjects had disappearance of swelling/pain, almost all had less leg heaviness, and 33% had resolved leg heaviness compared to placebo (8).

• Pycnogenol appeared to protect against deep vein thrombosis (DVT) and superficial vein thrombosis (SVT) on flights over 8 hour average time after a dose of 200 mg 2-3 hours before flying, 200 mg six hours later and 100 mg the day after flying (10). No subjects on pycnogenol developed thrombosis vs. 5.15% of placebo patients (10).