Armando Mansilha1, Joel Sousa2. 1. Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal - vascular.mansilha@gmail.com. 2. Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal.
Abstract
INTRODUCTION: Lower limb varicose veins can be treated effectively with endovenous ablation procedures or with minimally invasive open techniques. However, these procedures may cause pain and discomfort, and surgical stripping can be associated with long recovery times. We investigated whether venoactive drugs (VAD) used to treat chronic venous disease (CVD), provide benefits to patients recovering from a surgical or endovenous varicose vein procedure. EVIDENCE ACQUISITION: We conducted a systematic review of the literature to identify clinical trials investigating VAD therapy before, during, or after a surgical, endovenous, or sclerotherapy procedure for varicose veins. Records retrieved from the PubMed and Embase databases were screened for relevant studies. Full-length articles in English were obtained for analysis. EVIDENCE SYNTHESIS: We identified five clinical trials investigating the effects of VAD on recovery after surgery, endovenous ablation, or sclerotherapy. Studies were conducted in Russia, Italy, and Czech Republic and varied considerably in design, but all were unblinded open-label studies. All studies reported the use of micronized purified flavonoid fraction (MPFF); in one study, sulodexide was also used. Three studies reported significantly less post-procedural pain with MPFF treatment, with one reporting no significant effect. Two studies reported significant reductions in post-procedural bleeding with MPFF treatment. Three out of four studies reported greater symptomatic improvement with MPFF treatment. CONCLUSIONS: Appropriate treatment with MPFF may help reduce post-procedural pain, hemorrhage, and CVD-specific symptoms. While adjunct VAD treatment seems promising, high-quality placebo-controlled studies are needed to unequivocally demonstrate its benefits.
INTRODUCTION: Lower limb varicose veins can be treated effectively with endovenous ablation procedures or with minimally invasive open techniques. However, these procedures may cause pain and discomfort, and surgical stripping can be associated with long recovery times. We investigated whether venoactive drugs (VAD) used to treat chronic venous disease (CVD), provide benefits to patients recovering from a surgical or endovenous varicose vein procedure. EVIDENCE ACQUISITION: We conducted a systematic review of the literature to identify clinical trials investigating VAD therapy before, during, or after a surgical, endovenous, or sclerotherapy procedure for varicose veins. Records retrieved from the PubMed and Embase databases were screened for relevant studies. Full-length articles in English were obtained for analysis. EVIDENCE SYNTHESIS: We identified five clinical trials investigating the effects of VAD on recovery after surgery, endovenous ablation, or sclerotherapy. Studies were conducted in Russia, Italy, and Czech Republic and varied considerably in design, but all were unblinded open-label studies. All studies reported the use of micronized purified flavonoid fraction (MPFF); in one study, sulodexide was also used. Three studies reported significantly less post-procedural pain with MPFF treatment, with one reporting no significant effect. Two studies reported significant reductions in post-procedural bleeding with MPFF treatment. Three out of four studies reported greater symptomatic improvement with MPFF treatment. CONCLUSIONS: Appropriate treatment with MPFF may help reduce post-procedural pain, hemorrhage, and CVD-specific symptoms. While adjunct VAD treatment seems promising, high-quality placebo-controlled studies are needed to unequivocally demonstrate its benefits.