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Varicose Veins

 

Varicose veins Introduction

:varicose-vein.gif Varicose veins are elongated, tortuous, dilated superficial veins. They are usually present in the legs. Varicose veins result from incompetent valves that allow blood flow away from the heart. Increased pressure in the superficial veins also plays a role in the development of this condition. Over time, damage from increased pressure, incompetent valves, and chemical mediators (e.g. free radicals and enzymes) decrease the integrity of the vessel wall and dilation occurs. Once one area of the vein is compromised, the damage will continue along the course of the vein. [1]

Varicose veins affects both men and women, though women are affected up to three times as often as men. There is no known predisposition to any one particular race, though there is an increased prevalence in Western industrialized countries compared to developing countries. The peak incidence of occurrence is between the ages of 30 and 40. [2]

Family history, however, is a risk factor for the development of varicose veins. Pregnancy is also a risk factor for the development of varicose veins because of the hormonal changes and increased pressure on the pelvic veins. Prolonged standing will aggravate varicose veins, but standing alone, is not considered a risk factor for development. [3] Prior episodes of deep vein thrombosis can increase the chance of developing varicose veins. Some authors suggest that external trauma can also increase risk of developing varicose veins. [4]

Varicose veins Statistics

  • 1 in 5 adults or 15-25% in the US have varicose veins.
  • It is estimated that 50% of the US population over 50 years old has varicose veins.
  • The prevalence of varicose veins is greater in women (50-55%) compared to men (40-45%).
  • Women are three times more likely to have varicose veins than men.
  • It is estimated that 41% of all women 50 years old or greater have varicose veins.
  • Only 20-25% of women and 10-15% of men have visible varicosities.

Varicose Veins Symptoms

Varicose veins may be asymptomatic. Individuals may complain of heaviness and fatigue in the lower extremity. Edema may also be present. One of the most common complaints in newly formed varicosities is a dull aching pain, most likely due to the initial damage to the vessel. The skin overlying the varicose vein may be hot or warm to touch and it may itch. These symptoms do not correlate to the extent of damage or size of the varicosity. Often times, the larger dilated veins will present with only cosmetic complaints. [5]

The heaviness or aching in the leg will be relieved by walking and support hose, and may be exacerbated by standing for long periods of time. Individuals will often find a relief from symptoms by elevating legs. Varicose veins complaints are worse at night, in the summer months, and during menstruation due to increased edema. [6]

Varicose veins Treatment

Standard conventional varicose vein treatment is dependent on the severity of the varicosities. For small, mild varicosities with little or no symptoms, lightweight compression hose is recommended. When the veins become further dilated a more heavy-duty compression hose can be fashioned. Injection therapy is useful in treating all different sizes of varicose veins. This treatment hardens the vessels and they are no longer used for blood flow. It is an out patient procedure that can yield successful results. If the other treatment options have not been effective, the actual removal of the varicose vein may be warranted. It is important to note that this procedure is reserved for more severe cases, or when complications threaten the health of the individual. [7]

Alternative treatment using botanicals and vitamin supplements is focused on restoring integrity to the vessel and treating the underlying cause of the varicosities. Many herbalists suggest that early treatment with botanicals can prevent severe varicosities from developing.

Supplements helpful for Varicose veins

Centella asiatica (Gotu kola) Numerous studies have been performed using the extract of Gotu kola. Gotu kola is useful in treating varicose veins. Extracts of the triterpenoid compounds in Gotu kola have been shown to improve connective tissue integrity, elevate anti-oxidant levels in the vessels, and improve capillary permeability. Gotu kola has been proven in studies to effectively regulate the metabolism in the connective tissue of the vascular walls, leading to an increase in integrity and strength. [8]

In one particular double-blind study, patients supplemented a titrated extract of Centella asiatica (TECA) for two months. This resulted in an improvement in symptoms such as lower limb heaviness, edema, and patient satisfaction. These results were further substantiated by overall improvements in venous tone. [9] In another study, extracts of Gotu kola reduced capillary filtration rate in comparison to placebo, resulting in less reported edema and improvement in pain symptoms. [10]

Aesculus hippocastanum (Horse Chestnut) The seeds of Horse chestnut contain a compound called escin. Escin possesses anti-edema and anti-inflammatory properties. It has also been shown to reduce the permeability of capillaries, increase tone, and inhibit an enzyme that breaks down the connective tissue matrix of the vessel wall. In study, Escin increased venous tone comparable to the use of compression stockings.

In another clinical trial, supplementation with Escin for 12 weeks resulted in a decrease in edema by over 25%; results that were significantly better compared to compression stockings. [11] Research has also been done to compare escin to synthetic flavonoids, concerning its ability to reduce the inflammation and permeability of vessels. Escin was found to be comparable to synthetic flavonoids. It effectively reduced capillary permeability, increased tone, and decreased inflammation.[12]

Ruscus aculeatus (Butcher’s broom) Butcher’s broom is known for its anti-inflammatory and vasoconstrictive effects. Its vasoconstrictive activity is via adrenergic receptors located within the vessel wall. [13] It is effective at increasing tone in varicose veins via its vasoconstrictive property, as well as being a potent astringent.

In a study using an extract of Ruscus, combined with a flavonoid and ascorbic acid, an immediate change in venous tone was noted after 45-60 minutes. [14] In another study using a standardized extract known as Cyclo 3, patients reported a decrease in the severity of varicosities and symptoms compared to placebo. [15]

Flavonoids Flavonoids have been thoroughly studied for their use as a treatment for varicose veins. Flavonoids are able to reduce capillary fragility, increase venous wall integrity, increase venous tone, and inhibit breakdowns of the connective tissue matrix in the wall of the vessel. One mechanism for this protective effect is that flavonoids modulate white blood cell adhesion to the vessel wall and prevent damage to the inner lining. If this damage would occur, small holes in the wall would result, thereby causing leakage of fluid. [16]

Many studies have compared the effectiveness of combining a flavonoid with a botanical extract to treat varicose veins. Flavonoids have shown such benefit, that several preparations can now be obtained with a botanical extract and flavonoid already combined. [12, 14]

Antioxidants Anti-oxidants should be a part of any treatment regimen for varicose veins. It is believed that free radicals cause a significant amount of damage to the vessel wall, enabling the integrity to be compromised. In one study, the levels of anti-oxidants, specifically Vitamins A and E, were found to be deficient in individuals with varicose veins. [17] Vitamin C has been used as a component in several synthetic compounds to treat varicose veins, because of its associated anti-oxidant properties. [12, 14]

References

[1] Beers M and Berkow R. The Merck Manual 17th Ed. 1999. PP: 1794-1797.

[2] Fitzpatrick T et al. Color Atlas and Synopsis of Clinical Dermatology 3rd Ed. 1997 McGraw-Hill New York. PP: 480-485.

[3] Beers M and Berkow R. The Merck Manual 17th Ed. 1999. PP: 1794-1797.

[4] Fitzpatrick T et al. Color Atlas and Synopsis of Clinical Dermatology 3rd Ed. 1997 McGraw-Hill New York. PP: 480-485.

[5] Beers M and Berkow R. The Merck Manual 17th Ed. 1999. PP: 1794-1797.

[6] Fitzpatrick T et al. Color Atlas and Synopsis of Clinical Dermatology 3rd Ed. 1997 McGraw-Hill New York. PP: 480-485.

[7] Beers M and Berkow R. The Merck Manual 17th Ed. 1999. PP: 1794-1797.

[8] Arpaia MR. Effects of centella asiatica extract on mucopolysaccharide metabolism in subjects with varicose veins. Int J Clin Pharmacol Res. 1990; 10(4): 229-233.

[9] Pointel JP, Boccalan H, and Cloaree M et al. Titrated extract of centella asiatica (TECA) in treatment of venous insufficiency of lower limb. Angiology 1987; 38: 46-50.

[10] Belcar GU et al. Improvement of capillary permeability in patients with venous hypertension after treatment with TTFCA. Angiology 1990; 41: 533-540.

[11] Diehm C et al. Comparison of leg compression stockings and oral horse-chestnut seed extract therapy in patients with chronic venous insufficiency. Lancet 1996; 347: 292-294.

[12] Frick RW. Three treatments for chronic venous insufficiency: escin, hydroxyethylrutoside, and Daflon. Angiology. 2000 Mar; 51(3): 197-205.

[13] Miller VM, Rud KS, and Gloviczki P. Pharmacological assessment of adrenergic receptors in human varicose veins. Angiol. 2000 Jun; 19(2): 176-183.

[14] Cappelli R, Nicora M, and DiPerri T. Use of extract of ruscus aculeatus in venous disease in the lower limbs. Drugs Exp Clin Res. 1988; 14(4): 277-283.

[15] Boyle P, Diehm C, and Robertson C. Meta-analysis of clinical trials of cyclo 3 fort in the treatment of chronic venous insufficiency. Int Angiol. 2003 Sep; 22(3): 250-262.

[16] Smith PD. Micronized purified flavonoid fraction and the treatment of chronic venous insufficiency: microcirculatory mechanisms. Microcirculation 2000; 7(P6+2):S35-40.

[17] Rojas AI and Phillips TJ. Patients with chronic leg ulcers show diminished levels of Vitamin A, Vitamin E and zinc. Dermatol Surg. 1999 Aug; 25(8): 601-604.