Pharmacological treatment in patients with C4, C5 and C6 venous disease.
BACKGROUND
A range of surgical, endovenous, physical and medical treatments are available for patients with chronic venous disease. The aim of this review was to evaluate the evidence for pharmacological agents used for the treatment of chronic venous disease.


METHODS
A literature search was performed using Pubmed, Embase, Cochrane and Google Scholar databases. The initial search terms 'varicose vein', 'venous ulcer', 'venous disease' and 'lipodermatosclerosis' were used to identify relevant clinical studies of pharmacotherapy in patients with chronic venous disease (C4-C6).


RESULTS
A huge range of naturally occurring and synthetic drugs have been studied in patients with chronic venous disease. For patients with C4 venous disease, micronized purified flavonoid fraction (MPFF), oxerutin, rutosides and calcium dobesilate may reduce venous symptoms and oedema. MPFF and pentoxifylline have been shown to improve venous ulcer healing when used in addition to multilayer compression bandaging. The clinical benefits of other medications remain unproven. Reliability of meta-analyses was limited by study heterogeneity, small sample sizes and lack of long-term follow-up.


CONCLUSIONS
In prospective randomized studies, MPFF (Daflon(®)), other flavonoid derivatives and pentoxifylline have demonstrated clinical benefits in patients with C4-C6 venous disease. Pharmacotherapy should be part of a range of treatment options in the modern management of patients with chronic venous disorders.
Gohel
M S
MS
Imperial Vascular Unit, Imperial College London, Charing Cross Hospital, London, UK.
Davies
A H
AH
D002123:Calcium Dobesilate / Q000627:therapeutic use; D002309:Cardiology; D002908:Chronic Disease; D058128:Compression Bandages; D004358:Drug Therapy / Q000379:methods; D005419:Flavonoids / Q000627:therapeutic use; D006801:Humans; D006896:Hydroxyethylrutoside / Q000031:analogs & derivatives / Q000627:therapeutic use; D006973:Hypertension / Q000188:drug therapy; D010431:Pentoxifylline / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012431:Rutin / Q000627:therapeutic use; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000188:drug therapy*; D014689:Venous Insufficiency / Q000188:drug therapy*
D005419:Flavonoids; D006896:Hydroxyethylrutoside; D002123:Calcium Dobesilate; D012431:Rutin; C005865:troxerutin; D010431:Pentoxifylline