Venous insufficiency

MANAGING THROMOOEMOOLIC EFFECTS. The nurse monitors the patient for signs of thromboembolic effects, such as pain, swelling, tenderness in die extremities, headache, chest pain, and blurred vision. These adverse effects are reported to die primary health care provider. Patients with previous venous insufficiency, who are on bed rest for other medical reasons, or who smoke are at increased risk for tiiromboembolic effects. The nurse encourages the patient to elevate the lower extremities when sitting, if possible, and to exercise the lower extremities by walking. 

The efficacy of chitosan in the treatment of leg ulcers stems from its antiinflammatory action and stimulation of epithehahzation. Chitosans stimulate the granulation process and the epidermis formation, thus accelerating heahng, even in the elderly suffering from chronic venous insufficiency, the... 

Besides being powerful antioxidants, flavonoids are the most important family of phlebotropic drugs. Their properties of vein protection have proved to be of great help in the treatment of venous insufficiency. Daflon 500 mg (Servier Laboratories, France) is a micronized fraction of flavonoids composed of a mixture of diosmin (90%) and hesperidin (10%), which has become one of the preferred medicines for the treatment of chronic venous deficiency. This drug facilitates the contractility of the venous wall,... 

K. Roztocil, V. Stvrtinova and J. Strejcek, Efficacy of a 6-month treatment with Daflon 500 mg in patients with venous leg ulcers associated with chronic venous insufficiency. Int. Angiol. 22 (2003) 24-32. 

Various natural, chemically modified and mixtures of flavonoids are widely used therapeutically as venous protective or venotonic drugs in chronic venous insufficiency and haemorrhoidal attacks. Flavonoids have been found to inhibit increased vessel wall permeability, fluid changes in the capillary bed and diffusion of plasma proteins. In addition, they may exert a protective effect on the perivascular tissues due to their antihyaluronidase effect and the inhibition of lysine oxidase (producing crosslinks in collagen and elastin) and lysosomal hydrolases (degrade glycosamines). All these effects may account for the venotonic effects of these drugs [5]. However, the venous effects of flavonoids are out of the scope of the present review. 

Lyseng-Williamson KA, Perry CM. 2003. Micronised purified flavonoid fraction A review of its use in chronic venous insufficiency, venous ulcers and haemorrhoids. Drugs 63 71-100. 

The edema-reducing effects of class II compression stockings in patients with chronic venous insufficiency have been compared with those given either a placebo or a dried horse chestnut seed extract (HSCE, providing aescin 50 mg twice daily) in a randomized, partially blinded, parallel study. After 12 weeks of therapy, HSCE and compression produced equivalent mean decreases in lower-leg volume (44 and 47 ml, respectively), whereas a mean increase of 10 ml was observed in the placebo group. 

Post-phlebrtic syndrome, a complication of acute DVT is estimated to occur in approximately 4% of the population (213). This syndrome is characterized by persistent pain, edema, hyperpigmentation, induration of the skin, and stasis ulceration (214). The post-phlebrtic syndrome may be due to venous hypertension as a result of outflow obstruction or damage to the valves and in the cutaneous microcirculation may manifest as tissue hypoxia and lymphatic obstruction. Chronic venous insufficiency may lead to post-phlebetic syndrome. The syndrome may be the result of abnormalities in the superficial, the perforator, or the deep venous system. The diagnosis is purely clinical. The pharmacologic treament of post-phlebetic syndrome is rather limited, with pentoxifylline reported to improve the healing rate of skin ulcers. 

From the data as a whole, it appears that flavonoids do not have a negative impact on health, and some positive outcome was found. However, it is very hard to state which flavonoid is responsible for positive effects. No epidemiological data on supplements are available. A long-term study on chronic venous insufficiency (CVI) showed that high dosages of an herbal medicine containing mainly quercetin were effective in the treatment of mild CVI (75). 

Kiesewetter H, Koscienly J, Kalus U, et al. Efficacy of orally administered extract of red wine leaf as 195 (folia vitis viniferae) in chronic venous insufficiency (stages l-ll). A randomized, double blind, placebo-controlled trial. Arzneimittelforshung 2000 50 109-1 17. 

Herbs have been used as medical treatments since the beginning of civilization and some herbal derivatives (e.g., aspirin, reserpine, and digitalis) have become a mainstay of human pharmacotherapy. For cardiovascular diseases, herbal treatments have been used in patients with congestive heart failure, systolic hypertension, angina pectoris, atherosclerosis, cerebral insufficiency, venous insufficiency, and arrhythmia. Scientific validation of several plant species has proved the efficacy of the botanicals in reducing the... 

HT-R antagonist (HIS-R) [for oedema, chronic venous insufficiency haemorrhoids] 5HT-R antagonist - 5HT2-R (HIS-R) [for oedema, chronic venous insufficiency haemorrhoids T GI transit]... 

HIS-R antagonist (5HT-R) [for oedema, chronic venous insufficiency haemorrhoids]... 

Heparan sulfete has been studied in DVT, chronic venous insufficiency and intermittent claudication (30,33). Although small numbers of patients were included in these trials, there appears to be positive results obtained with this agent. 

Agrati AM, DeBartolo G, Palmieri G Hqraran sulfate Efficacy and safety in patients with chronic venous insufficiency. Minerva Cardioan logioa (1991) 39(10) 395-400. 

Melilotus officinalis (sweet clover) contains coumarin, 3,4-dihydrocoumarin (melilotine), ortho-coumaric acid, ortho-hydroxycoumaric acid, and the ortho-glucoside of ortho-coumaric acid (melilotoside). Withering of the plant leads to enzymatic glycoside hydrolysis and the resulting ortho-coumaric acid is spontaneously transformed to coumarin the dried herb therefore smells strongly of coumarin (see separate monograph). M. officinalis has been used to treat lymphedema and the edema of chronic venous insufficiency. 

Patients with chronic venous insufficiency and venous leg ulcers are at risk of sensitization to topical medications. The frequency of sensitization in these patients is up to 67% (11). In a study using an expanded European standard series and 20 different wound dressings for patch-testing in 36 patients with chronic venous insufficiency, sensitization to fragrance mix was found in three cases (12). 

Gallenkemper G, Rabe E, Bauer R. Contact sensitization in chronic venous insufficiency modern wound dressings. Contact Dermatitis 1998 38(5) 274-8. 

A systematic review of randomized trials of extracts of horse chestnut in chronic venous insufficiency showed that adverse effects are usually mild, for example pruritus, nausea, headache, dizziness, and gastrointestinal symptoms (1). 

Pittler MH, Ernst E. Horse-chestnut seed extract for chronic venous insufficiency. A criteria-based systematic review. Arch Dermatol 1998 134(ll) 1356-60. 

Ruscus aculeatus (butcher s broom, knee holy, knee holly, knee holm, Jew s myrtle, sweet broom, pettigree) has been used topically for vasoconstrictor treatment of varicose veins and hemorrhoids (15), and for chronic venous insufficiency, both alone (16,17) and in the combination known as Cyclo 3 fort, marketed in France, which contains an extract of R. aculeatus 150 mg, hesperi-din methyl chalcone 150 mg, ascorbic acid 100 mg, and metesculetol. 

In a meta-analysis of the efficacy of Cyclo 3 fort in patients with chronic venous insufficiency 20 doubleblind, randomized, placebo-controlled studies and 5 randomized comparison studies in 10 246 subjects were included (18). Cyclo 3 fort significantly reduced the severity of pain, cramps, heaviness, and paresthesia compared with placebo. There were also significant reductions in venous capacity and severity of edema. 

Vanscheidt W, lost V, Wolna P, Lucker PW, Muller A, Theurer C, Patz B, Grutzner KL Efficacy and safety of a Butcher s broom preparation Ruscus aculeatus L. extract) compared to placebo in patients suffering from chronic venous insufficiency. Arzneimittehorschung 2002 52(4) 243-50. 

Boyle P, Diehm C, Robertson C. Meta-analysis of clinical trials of Cyclo 3 Fort in the treatment of chronic venous insufficiency. Int Angiol 2003 22(3) 250-62. 

Indications Edema associated with chronic venous insufficiency. 

Alprostadil, Prostaglandin Ei (Taisho) Palux, Liple, Englandin 1) Venous insufficiency 2) Diabetic skin ulcers 3) Peripheral vasodilator 115-116°C 3.20 (experimental)... 

Aesculus hippocastanum (horse chestnut) used for the treatment of chronic venous insufficiency ... 

Baisi F. Report on Clinical Trial of Bilberry Anthocyanocides in the Treatment of Venous Insufficiency in Pregnancy and of Postpartum Hemorrhoids. Presidio Ospedaliero di Livorno, Italy, 1987. 

Corsi S. Report on Trial of Bilberry Anthocyanosides (Tegens-inverni della beffa) in the Medical Treatment of Venous Insufficiency of the Lower Limbs. Casa di Cura S. Chiara, Florence, Italy, 1987. 

Diehm C, Trampisch HJ, Lange S, Schmidt C. Comparison of leg compression stocking and oral horse-chestnut seed extract therapy in patients with chronic venous insufficiency. Lancet 1996 347 292-294. 

The client diagnosed with chronic venous insufficiency has a venous stasis ulcer that is being treated with autolytic medication for debridement and an occlusive dressing. The nurse notices a foul-smelling odor. Which action should the nurse take ... 

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