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Varicose veins

MagazineDecember 2010 (Vol. 21 Issue 9)Varicose veins

Varicose veins are veins that have become twisted and swollen because blood isn't flowing through them properly

Varicose veins are veins that have become twisted and swollen because blood isn't flowing through them properly. They can develop anywhere in the body, but the veins in the legs are the most commonly affected, as they have to move blood along against gravity. Increased blood pressure and hormonal changes during pregnancy can also trigger the problem, which helps to explain the higher incidence of varicose veins in women than in men (Cochrane Database Syst Rev, 2007; 1: CD001066).

For many sufferers, varicose veins are simply a cosmetic concern. Others, however, may experience aching, throbbing, itching or burning sensations, which usually worsen with pro-longed standing.

Rarely, varicose veins can lead to more serious problems such as infection, leg ulcers and thrombo-sis (Am Fam Physician, 2008; 78: 1289-94).

Treating varicose veins

Conventional treatment of varicose veins includes a range of options-from compression stockings to surgery and laser treatments. Compression stockings, which steadily squeeze the legs to improve blood flow, are usually the first course of action, but studies conclude that they are no more effective than simply resting (Cochrane Database Syst Rev, 2007; 1: CD001066).

Surgery, on the other hand, can effectively get rid of these unsightly veins and help to relieve symptoms. However, varicose veins may gradually recur through a process of 'neovascularization'-regrowth and enlargement of veins-even after successful surgery, or they may simply develop elsewhere in the legs (BMJ, 2006; 333: 287-92). Other possible complications include bleeding, bruising, infec-tion, scarring and nerve damage. There is also evidence that suggests that surgery for varicose veins might even increase the risk of thrombosis (blood clots) (BMJ, 1996; 312: 1158).

Two newer treatments are radiofrequency abla-tion and laser treatment, which use heat to seal off varicose veins. These less invasive techniques appear to be at least as effective as surgery, but with fewer risks (J Vasc Surg, 2009; 49: 230-9).

Nevertheless, we still don't know how safe and effective these treat-ments are in the long term.

Yet another option is sclero-therapy, in which chemicals are injected into varicose veins to cause their walls to collapse. This can be effective for smaller varicose veins, but the risk of neovascularization remains high. There are also concerns over the development of deep vein thrombo-sis (DVT), visual disturbances and stroke (Am Fam Physician, 2008; 78: 1289-94; J Neurol Neurosurg Psychiatry, 2010; 81: 582-3).

Happily, there are a number of natural ways to treat varicose veins.

Natural remedies

Supplements

Among the most useful supplements are those that contain flavonoids, some of which have anti-inflammatory effects and can help to strengthen the blood vessels.

o Hydroxyethylrutoside (HR), a type of flavonoid derived from rutin (found in buckwheat and asparagus), improved varicose veins in a controlled trial of pregnant women (Zentralbl Gynakol, 1995; 117: 190-7). Typically, the HR dose is 1000 mg/day, but its efficacy may be increased by combining the supplement with topical HR gel, applied two to three times a day (Angiology, 2008; 59 Suppl 1: 7S-13S).

o Proanthocyanidins, flavonoids found naturally in apples, pine bark, grapeseed, bilberry and some red wines, have also been successfully used to treat varicose veins. A single dose of proanthocyanidins (150 mg) improved leg-vein function in people with widespread varicose veins (Sem Hop, 1981; 57: 2009-13).

o Daflon, a combination of the flavonoids diosmin and hesperi-din, has been shown to be effective for chronic venous insufficiency (CVI; pooling of blood in the legs), a condition commonly associated with varicose veins. According to one review, its comprehensive mode of action on the veins, lymphatic vessels and microcirculation makes it the treatment of choice not only for the early stages of CVI, but also for the more severe stages, too (Angiology, 2001; 52 Suppl 1: S49-56).

o Pycnogenol (maritime pine-bark extract) may be even more effective than Daflon, according to one study. Italian researchers found that, after eight weeks, CVI patients taking 150 or 300 mg/day of Pycnogenol improved more than those taking 1000 mg/day of Daflon (Clin Appl Thromb Hemost, 2006; 12: 205-12).

Herbs

Plant remedies are a popular treatment for varicose veins, and the following appear to be especially useful.

o Horse chestnut (Aesculus hippocastanum). Extracts from the seeds of this plant (HCSE) have traditionally been used to treat patients with CVI and to alleviate its associated symp-toms. Four clinical trials in patients with CVI and one study in patients with varicose veins showed that HCSE-taken either as an oral tincture or tablets (20 mg or 50 mg), or applied as a topical gel-can reduce leg pain and swelling as well as heaviness and itching (Adv Ther, 2006; 23: 179-90). For best results, take it as early in the condition as possible (BMC Cardiovasc Disord, 2001; 1: 5; doi: 10.1186/1471-2261-1-5).

o Gotu kola (Centella asiatica). This appears to have a beneficial effect on the connective tissues in varicose veins (Int J Clin Pharmacol Res, 1990; 10: 229-33). In a randomized placebo-controlled trial-the 'gold standard' of scientific evaluation-a titrated extract of gotu kola (60 or 120 mg/day) was effective for reducing leg swelling and leg heaviness in patients with CVI (Angiology, 1987; 38: 46-50).

o Butcher's broom (Ruscus aculeatus). Taken orally, this herb can improve venous tone and poor circulation (Fortschr Med, 1989; 107: 52, 55-8). In a placebo-controlled trial of 148 women with CVI, those taking butcher's broom extract saw significant improvements in leg swelling as well as in heaviness, tension and tingling (Arzneimittelforschung, 2002; 52: 243-50). Dosage for capsules standardized for ruscogenins is 7-11 mg, although some experts recommend higher dosages of 16.5-33 mg of total ruscogenins three times a day (Altern Med Rev, 2001; 6: 608-12).

o Witch hazel (Hamamelis virginiana). This herb is famous for its astringent and anti-inflammatory properties (Altern Med Rev, 2001; 6: 608-12), and, in the form of an ointment, it is recommended by the German Commission E for varicose veins. Note, however, that the ointment may need to be applied three or more times a day for several weeks before there is any noticeable improvement.

o Red vine leaf (Folia vitis viniferae) extract. A source of flavonoids, this herb was able to reduce calf swelling in patients with CVI (Arzneimittelforschung, 2000; 50: 109-17). Another study concluded that red vine leaf extract shows "a fast onset of action and an excellent efficacy" in the treatment of CVI (Praxis [Bern 1994], 2006; 95: 187-90). The usual dose is 360-720 mg/day.

o Hydrotherapy. The use of water to treat illness appears to work for varicose veins. In a study of 61 patients, three and a half weeks of hydrotherapy reduced leg swelling and other symptoms of varicose veins (Vasa, 1991; 20: 147-52). In another study, thermal hydromassage therapy was also effective for patients with CVI (Minerva Cardioangiol, 2008; 56: 401-8).

o Reflexology. This form of foot massage reduced symptoms in a study of 55 women with varicose veins and leg swelling (Cochrane Database Syst Rev, 2007; 1: CD001066).

o Homeopathy. According to WDDTY columnist Dr Harald Gaier, there are several effective homeopathic remedies for varicose veins, including H. virginiana (witch hazel), Aristolochia clematis, Paeonia officinalis, Viburnum opulus and Ruta graveolens. For best results, see a qualified homeopath, who can prescribe a remedy based on your individual symptoms.

Joanna Evans

WDDTY VOL. 21 ISSUE 7


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