Chronic Venous Insufficiency

Also indexed as: CVI

Chronic venous insufficiency (CVI) may occur following excessive clotting and inflammation of the leg veins, a disease known as deep vein thrombosis. CVI also results from a simple failure of the valves in leg veins to hold blood against gravity, leading to sluggish movement of blood out of the veins, resulting in swollen legs.

Checklist for Chronic Venous Insufficiency

Rating Nutritional Supplements Herbs
3Stars Flavonoids (rutin)
Proanthocyanidins		 Horse chestnut
2Stars   Butcher’s broom
Gotu kola
Red vine leaf
3Stars Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star An herb is primarily supported by traditional use, or the herb or supplement has little scientific support and/or minimal health benefit.

What are the symptoms of chronic venous insufficiency? CVI may cause feet and calves to become swollen, often accompanied by a dull ache made worse with prolonged standing. If CVI is allowed to progress, the skin tends to darken and ulcers may occur. CVI often causes varicose veins.

How is it treated? It is typically advised to elevate the legs frequently, avoid prolonged standing or sitting, and wear graduated compression stockings with supportive shoes. Any ulcers that develop are treated with compressive bandages that contain antibiotic solutions. Recurrent ulceration may be surgically treated with skin grafts and repair or bypass of the affected veins.

Lifestyle changes that may be helpful: People affected by chronic venous insufficiency should not sit or stand for long periods of time. When sitting, they should elevate their legs. Walking helps move blood out of the veins. Wearing tight-fitting compression stockings available from pharmacies further supports the veins.

Nutritional supplements that may be helpful: Flavonoids promote venous strength and integrity. Most trials of flavonoids in patients with CVI have used a type of flavonoid called hydroxyethylrutoside (HR), which is derived from rutin. These double-blind and other controlled trials have consistently shown a beneficial effect of HR in clearing leg swelling and other signs of CVI.1 2 3 Positive results from a double-blind trial have been obtained using 500 mg of HR taken twice per day for 12 weeks.4 In this trial, the preparation was found to add further benefit to that provided by compression stockings commonly used to treat CVI. Similar results were obtained in another controlled trial.5 It is unclear whether other flavonoids are as effective as HR for CVI. HR has also been used successfully as a topical preparation for the treatment of CVI.6

Proanthocyanidins (OPCs), a group of flavonoids found in pine bark, grape seed, grape skin, bilberry, cranberry, black currant, green tea, black tea, and other plants, have also been shown to strengthen capillaries in double-blind research using as little as two 50 mg tablets per day.7 In a double-blind trial using a total of 150 mg OPCs per day, French researchers reported reduced symptoms for women with CVI.8 In another French double-blind trial, supplementation with 100 mg taken three times per day resulted in benefits within four weeks.9

Are there any side effects or interactions? Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful: According to an extensive overview of clinical trials, standardized horse chestnut seed extract, which contains the active compound aescin, has been shown to be effective in double-blind and other controlled research, supporting the traditional use of horse chestnut for venous problems.10 In these trials, capsules of horse chestnut extract containing 50 mg of aescin were given two to three times daily for CVI. The positive effect results in part from horse chestnut’s ability to strengthen capillaries, which leads to a reduction in swelling.11

Another traditional remedy for CVI is butcher’s broom. One double-blind trial used a combination of butcher’s broom, the flavonoid hesperidin, and vitamin C. This was found to be better than a placebo for treating CVI.12 In a comparison study, a product combining butcher’s broom extract, the flavonoid hesperidin, and vitamin C was more effective than a synthetic flavonoid product for treating CVI.13 Clinical trials have used one capsule, containing standardized extracts providing 15 to 30 mg of ruscogenins, three times each day. The amount of butcher’s broom extract used in these trials is 150 mg two times per day. Other sources recommend standardized extracts providing 15 to 30 mg of ruscogenins, given three times each day.

Gotu kola extracts, standardized to triterpenoid content, have been found successful in small preliminary trials to treat CVI.14 The amount of extract used in these trials ranged from 60 to 120 mg per day.

A double-blind trial demonstrated that red vine leaf extract is effective at relieving the symptoms and swelling associated with CVI.15 One group of participants took either 360 mg or 720 mg per day of a standardized extract for 12 weeks, and another group took a placebo. At the end of the treatment period, those who had taken the herb experienced significant improvement in symptoms of leg heaviness, tension sensation, tingling, and pain compared with those who had taken the placebo. Objective measurements of leg swelling were also significantly improved in the red vine group compared to the placebo group.

Are there any side effects or interactions? Refer to the individual herb for information about any side effects or interactions.

References:

1. Rehn D, Brunnauer H, Diebschlag W, Lehmacher W. Investigation of the therapeutic equivalence of different galenical preparations of O-(s-hydroxyethyl)-rutosides following multiple dose per oral administration. Arzneimittelforschung 1996;46:488–92.

2. Bergqvist D, Hallbook T, Lindblad B, Lindhagen A. A double-blind trial of O-(s-hydroxyethyl)-rutoside in patients with chronic venous insufficiency. Vasa 1981;10:253–60.

3. Poynard T, Valterio C. Meta-analysis of hydroxyethylrutosides in the treatment of chronic venous insufficiency. Vasa 1994;23:244–50.

4. Unkauf M, Rehn D, Klinger J, et al. Investigation of the efficacy of oxerutins compared to placebo in patients with chronic venous insufficiency treated with compression stockings. Arzneimittelforschung 1996;46:478–82.

5. Neumann HA, van den Broek MJ. A comparative clinical trial of graduated compression stockings and O-(beta-hydroxyethyl)-rutosides (HR) in the treatment of patients with chronic venous insufficiency. Z Lymphol 1995;19:8–11.

6. Frick RW. Three treatments for chronic venous insufficiency: escin, hydroxyethylrutoside, and Daflon. Angiology 2000;51:197–205 [review].

7. Dartenuc JY, Marache P, Choussat H. Resistance Capillaire en Geriatrie Etude d’un Microangioprotecteur. Bordeax Médical 1980;13:903–7 [in French].

8. Delacroix P. Etude en Double Avengle de l’Endotelon dans l’Insuffisance Veineuse Chronique. Therapeutique, la Revue de Medicine 1981;Sept 27–28:1793–1802 [in French].

9. Thebaut JF, Thebaut P, Vin F. Study of Endotelon in functional manifestations of peripheral venous insufficiency. Gazette Medicale 1985;92:96–100 [in French].

10. Pittler MH, Ernst E. Horse-chestnut seed extract for chronic venous insufficiency: a criteria-based systematic review. Arch Dermatol 1998;134:1356–60.

11. Bisler H, Pfeifer R, Klüken N, Pauschinger P. Effects of horse-chestnut seed extract on transcapillary filtration in chronic venous insufficiency. Deutche Med Wochenschr 1986;111:1321–9 [in German].

12. Cappelli R, Nicora M, Di Perri T. Use of extract of Ruscus aculeatus in venous disease in the lower limbs. Drugs Exp Clin Res 1988;14:277–83.

13. Beltramino R, Penenory A, Buceta AM. An open-label, randomized multicenter study comparing the efficacy and safety of Cyclo 3 Fort® versus hydroxyethyl rutoside in chronic venous lymphatic insufficiency. Angiology 2000;51:535–44.

14. Brinkhaus B, Linder M, Schuppan D, Hahn EG. Chemical, pharmacological and clinical profile of the East Asian medical plant Centella asiatica. Phytomedicine 2000;7:427–48.

15. Kiesewetter H, Koscielny J, Kalus U, et al. Efficacy of orally administered extract of red vine leaf AS 195 (folia vitis viniferae) in chronic venous insufficiency (stages I-II). A randomized, double-blind, placebo-controlled trial. Arzneimittelforschung 2000;50:109–17.