Efficacy of Venoactive Substances and Drugs in the Treatment of Chronic Venous Insufficiency and Varicose Veins: A Narrative Review

Chronic venous insufficiency (CVI) and varicose veins are common conditions that cause symptoms such as heavy legs, swelling (oedema), skin discolouration, lipodermatosclerosis, venous ulcers, venous congestion, and reflux. To gather information for this review, the following keywords were used in PubMed: "varicose veins," "chronic venous insufficiency," "venoactive compounds (VAC)," and "venoactive drugs (VAD)," and a narrative review was then conducted to assess the efficacy of venoactive agents. Treatment includes venoactive medications, with the investigated substances being micronized purified flavonoid fraction (MPFF), a combination of Ruscus aculeatus, hesperidin methyl chalcone (HMC) and vitamin C, rutosides, hydroxyethylrutosides (HR), Ruscus aculeatus, pycnogenol, aescin, red vine leaf extract, calcium dobesilate, pentoxifylline, topical agents, and sulodexide. Venotonic medications have similar effects on the venous endothelium, lymphatic drainage, oedema, venous tone, leukocyte adhesion, inflammatory mediators, blood viscosity, and red blood cell behaviour. Study results concerning symptoms like pain, cramps, heaviness, and swelling show some variation; however, micronised purified flavonoid fractions (MPFF) and ruscus extract combined with hesperidin methyl chalcone and ascorbic acid demonstrated the highest quality of evidence, primarily at level A. For venous leg ulcers, MPFF, sulodexide, and pentoxifylline were effective adjunctive treatments, also supported by level A evidence. Additionally, the concept of venous active drugs (VAD) has been introduced to prevent deterioration of venous status, including arterial vascular changes, and although study quality varies, recent research tends to be more positive. In conclusion, the efficacy of venoactive compounds and drugs (VAC/VAD) in treating CVI and varicose veins has been confirmed by several studies, and recent research has achieved a level of evidence that supports recommendations in international guidelines; nonetheless, there is a clear need for further high-quality studies.