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Health Protocols

Chronic Venous Disease: Varicose Veins And Venous Insufficiency

Chronic venous disease is a condition in which blood does not flow efficiently through the veins in the legs toward the heart. Spider veins and varicose veins are common signs of early-stage chronic venous disease.

Untreated varicose veins are associated with increased risk of deep vein thrombosis (DVT)—potentially deadly blood clots in the legs. Therefore, varicose veins and chronic venous disease should be taken seriously even in the early stages.

Phlebotonics are compounds that improve circulatory function, such as horse chestnut seed extract, diosmin, pycnogenol, and Centella asiatica.

Risk Factors

  • Increasing age
  • Female gender
  • Tall stature
  • Family history
  • Previous history of DVT in the legs
  • Pregnancy
  • Prolonged sitting or standing
  • Obesity

Signs, Symptoms and Complications

  • The early stages of venous disease may have no symptoms. As the disease progresses, several symptoms affecting the legs may arise, including heaviness, tiredness, itching, cramps, tingling, swelling, and pain.
  • Clinical Classification of Chronic Venous Disease
    • C0: No visible or palpable sign of venous disease
    • C1: Spider veins or reticular veins (veins that “feed” spider veins)
    • C2: Varicose veins
    • C3: Edema (swelling)
    • C4: Changes in skin and tissues
      • A: Pigmentation or eczema
      • B: Thickening, hardening, swelling, redness, inflammation, scarring
    • C5: Healed venous ulcer
    • C6: Active venous ulcer

Note: Some potential complications of venous disease, such as DVT, can occur even in people who have no overt signs. One potentially deadly consequence of DVT is pulmonary embolism when the blood clot dislodges from the deep vein and travels to the lungs. Anyone who suspects they may have a DVT should consult a qualified healthcare provider right away.

Conventional Treatment Includes:

  • Compression therapy. Compression can be accomplished with stockings (the most common form), bandages, boots, and pneumatic devices.
  • Sclerotherapy. This common procedure involves injecting a compound into the vein to damage the vessel lining, causing the vein to degrade and eventually be reabsorbed by the body.

Novel and Emerging Therapies Include:

  • CHIVA, a French acronym for “conservative hemodynamic cure for venous insufficiency,” is unique among venous disease treatments in that it preserves rather than destroys superficial veins.
  • Oxerutin, a mixture of semisynthetic flavonoids derived from rutin, is commonly used in Europe in the treatment of venous disorders. Multiple clinical trials have demonstrated that oxerutin reduces edema and pain associated with venous disease.

Dietary and Lifestyle Considerations Include:

  • Physical activity encourages return of venous blood from the legs back to the heart by activating the pumping action of the muscles.
  • Weight loss reduces pressure on leg veins and improves blood circulation.
  • A high-fiber diet can help prevent varicose veins by producing soft, well-formed stools to ease bowel movements and eliminate chronic straining.

Integrative Interventions Include:

  • Diosmin. A naturally occurring flavonoid found in many plants. A 2016 review and analysis of randomized controlled trials found that diosmin significantly reduced leg and ankle swelling and lower leg pain.
  • Horse chestnut seed extract (Aesculus hippocastanum). A review and analysis of randomized controlled trials concluded that horse chestnut seed extract is a safe and effective short-term treatment for chronic venous insufficiency.
  • Pycnogenol. Pycnogenol, a standardized extract of French maritime pine bark, has been shown to promote healing of venous ulcers and reduce leg edema and the risk of blood clots during long flights.
  • Nattokinase. Nattokinase, a protein-digesting enzyme extracted from natto, has been shown in several laboratory studies to reduce the risk of blood clot formation and break up existing blood clots.
  • Centella asiatica (Gotu kola). A rigorous review of randomized controlled clinical trials found evidence that Centella asiatica likely exerts beneficial effects on the signs and symptoms of chronic venous insufficiency.