Dear Roberto Kazuo Miyake

I agree with you that have been invented many drugs for the treatment "per se" of chronic venous insufficiency, including the phlebotonics (horse chestnut, gingko biloba, diosmin and hesperidin) and antiplatelet drugs for patients at high risk venous thrombosis and pulmonary embolism (low-dose aspirin and gingko biloba), also anticoagulants (low molecular weight heparin, antithrombin III inhibitors, acenocumarine) for high risk patients.

The truth is that solid scientific evidence are very few, so that meta-analyzes and systematic reviews have been conducted to this end, only show a tendency to effectiveness without being overwhelming, like those made by the Therapeutic Guide IMSS clinic and the Cochrane Review Group. Where if there is strong evidence to the non-pharmacological treatment (venous hygiene measures, compression therapy).

Annex articles that illustrate the evidence.

Best regards

Sincerely

Dr. Jose Luis Garcia Vigil

Very nice input. On fact is that patients tend to use phlebotonics when the legs are in the heaviest days! Then, they feel improvement and tell others. For most people, the friends testimonial is more important than any medical evidence that the doctor might say during the consultation.

Compliance in pharmacotherapy in patients with chronic venous disorders.

Chudek J1, Kocełak P, Ziaja D, Owczarek A, Ziaja K.

Abstract

AIM:

The aim of this study was to evaluate the factors that limit the use of venoactive drugs (VADs), especially in patient with chronic venous disorders (CVD) noncompliant with compression therapy in a nationwide survey.

METHODS:

Analysis included 5134 CVD patients compliant with compression therapy and 4663 of those not accepting such method of therapy, participating in a large survey.

RESULTS:

Venoactive drugs (VADs) and topical agents were used significantly less frequently by patients noncompliant with compression therapy compared to the compliant population (95.2% vs. 97.7%, P

Indeed many patients report some improvement in symptoms related to chronic venous insufficiency, such as edema, dryness and itching of the skin, decreased pain etc ... The important thing is to define and separate the real effect of phlebotonic, without having to see the placebo and expectations of patients effect. Systematic reviews based on randomized controlled trials and meta-analyzes, which are separated by design and method (as far as humanly possible) the actual effect (efficacy and safety of medicines) with clinical improvement on expectations and placebo effect

Also agree that what truly proven scientifically based, is the effectiveness of non-pharmacological treatment, particularly compression therapy and venous hygiene measures.

Again I do this to stay abreast of developments in the questions regarding the scientific evidence phlebotonics for the treatment of venous insufficiency.

At the moment, there is nothing new to add (new investigations and other results) to what we have already expressed and documented previously

Greetings to all participants of this discussion group and especially its founder Dr. Roberto Kazuo Miyake

Dear colleague, the basis of non-invasive treatment of chronic venous disease are general measures, compression therapy and pharmacotherapy. With regard to the latter, they have published clinical practice guidelines which placed some drugs as valid to reduce symptoms such as heaviness, pain, swelling, cramps, itching, etc. option The Ultimate Guide has been published by the European Society for Vascular Surgery 2015, which is given a class IIa evidence and grade of recommendation A venotonic drugs for pain relief and venous edema, and treatment venous ulcer. I suggest you read it and appreciate the references. In addition, last year the guidance of the International Union of Angiology for the management of chronic venous insufficiency, where the use of drugs venotonic also says it was published.

There will always individualize treatment considering the general measures and are based compression therapy to halt the progression of chronic venous disease.

I hope I've been helpful.

A greeting

Efectivamente la terapia de compresión y las medidas de higiene venosa son las únicas donde se ha demostrado efecto significativo directo en la insuficiencia venosa crónica; es decir, mejoría en el tono de la pared vascular venosa y por ende, mejoría en la circulación.

Los datos clínicos asociados a la insuficiencia venosa crónica, como es la alteración de la piel cercana al estancamiento de la sangre venosa, flebitis y ulceración (sequedad, prurito, alteraciones de la sensibilidad, enrojecimiento, inflamación, infección y la formación de trombos e hiperpigmentación), si llegan a mejorar con farmacoterapia sistémica y local (antisépticos, antibióticos, antiplaquetarios, hemorreológicos, analgésicos antiinflamatorios y estimulantes de la cicatrización), pero no son resultado del efecto directo de los medicamentos llamados flebotónicos en el tono de la pared vascular del territorio venoso.

Saludos cordiales

Atentamente

Dr. José Luis García Vigil

PD: Envío versión en Español e Inglés para evitar problemas de interpretación, semánticos y de comunicación, inherentes a la traducción,

Indeed compression therapy and venous hygiene measures are the only ones that have shown significant direct effect on chronic venous insufficiency; that is, improvement in the tone of the venous vascular wall and hence, improvement in circulation.

Clinical data associated with chronic venous insufficiency, such as the alteration of the skin near the stagnation of venous blood, phlebitis and ulceration (dryness, itching, abnormal sensitivity, redness, swelling, infection, thrombus formation and hyperpigmentation), if they improve with systemic and local pharmacotherapy (antiseptics, antibiotics, anti-platelet, hemorheologic, anti-inflammatory and stimulating painkillers healing), but they are not a result of the direct effect of drugs called phlebotonics in the tone of the vascular wall of the venous territory.

Best regards

Sincerely

Dr. Jose Luis Garcia Vigil

PD: Shipping version in Spanish and English to avoid problems of interpretation, semantic and communication inherent in the translation,

muchas gracias Dr Jose Luis Gracia Vigil por la respuesta mui interessante. Concordo con todas las afirmaciones. Me gusta la version en Español para entrenar el idioma! :D