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Issue # 66.9 - Circulatory HealthAnswer to Varicose Veins? A varicose vein is a superficial vessel that is abnormally lengthened, twisted, or dilated, seen most often on the legs and thighs. Varicose veins develop spontaneously and are usually attributed to a hereditary weakness of the vein. The valves in the vein that keep the blood circulation upward toward the heart are usually incompetent. Increased pressure from long standing or exertion, or internal factors such as pregnancy, or lessened support by the tissues surrounding the veins that occur with ageing and obesity cause the weakened veins to dilate. Extracts of horse-chestnut seed standardised for aescin (a key component) appear to be as effective as compression stockings without the nuisance. For example, in a well-designed study, the effectiveness of horse chestnut seed extract versus leg compression stockings was examined in 240 patients with varicose veins. Patients received either horse chestnut seed extract (50mg of aescin a day), compressed stockings, or a placebo. Patients were treated over a period of twelve weeks. Effectiveness was evaluated by a machine that measures the volume of fluid in the leg. After the three week trial, lower leg volume of the more severely affected leg decreased an average of 56.5ml with compression therapy and 53.6 ml with horse chestnut seed extract while it increased by 9.8 ml with placebo. Compression stockings and horse chestnut seed extract produced nearly identical reductions in oedema. So why take the horse chestnut rather than wear the stockings? These are not regular stockings; they are made from special material, very expensive, and are quite difficult to put on, not to mention uncomfortable to wear. Horse chestnut seed extracts standardised for aescin exert anti-oedema and anti-inflammatory properties, and decrease capillary permeability by reducing the number and size of the small pores in the capillary walls. The reduction in capillary permeability and oedema appears to result from inhibition of the enzymes that break down the support structures of the vein. Lancet. 1996 Feb 3;347(8997):292-4 Improvement in CVI related signs? Conservative therapy of chronic venous insufficiency (CVI) consists largely of compression treatment. However, this often causes discomfort and has been associated with poor compliance. Therefore, oral drug treatment is an attractive alternative. The objectives of this trial were to review the evidence from rigorous clinical trials assessing the efficacy and safety of oral horse chestnut seed extract (HCSE) versus placebo, or other treatments for CVI. Overall, there appeared to be an improvement in CVI related signs and symptoms with HCSE compared with placebo. Leg pain was assessed in seven placebo-controlled trials. The evidence presented implies that HCSE is an efficacious and safe short-term treatment for CVI. However, several caveats exist and more rigorous RCTs are required to assess the efficacy of this treatment option. Cochrane Database Syst Rev. 2004;2:CD003230 |