Venous Insufficiency Medication
- Author: Robert Weiss, MD; Chief Editor: William D James, MD more...
No oral medication has yet been proven useful for the treatment of venous disease. Findings of prospective studies have not supported some manufacturers’ claims about the effectiveness of their herbal products and nutritional supplements.
Sclerosing agents that are used to ablate refluxing veins and other anatomic structures can be grouped into several categories, including fatty alcohols (detergents), osmotic agents, and caustic agents. The safest and most widely used sclerosing agents are detergents.
Sclerosing agents are used for the primary sclerosis of reflux pathways and for the ablation of friable thin-walled veins judged to be at high risk for rupture and hemorrhage.
Primary sclerotherapy is the treatment of choice for ablation of refluxing superficial venous circuits in the absence of saphenofemoral junctional reflux. It is also the treatment of choice for ablation of venous bleeding sites and friable thin-walled varices. In general, a 1% concentration is most useful; in larger varicosities, a 3% concentration may be used as a liquid. Foam may be made by agitating a 1:4 mixture of solution and air. When a foamed solution is used, a concentration of 0.25-0.5% is sufficient.
Renner R, Gebhardt C, Simon JC, Seikowski K. Changes in quality of life for patients with chronic venous insufficiency, present or healed leg ulcers. J Dtsch Dermatol Ges. 2009 Nov. 7(11):953-61. [Medline].
Zaniewski M, Simka M. Biophysics of venous return from the brain from the perspective of the pathophysiology of chronic cerebrospinal venous insufficiency. Rev Recent Clin Trials. 2012 May. 7(2):88-92. [Medline].
Bryan LJ, Callas PW, Criqui MH, Cushman M. Higher soluble P-selectin is associated with chronic venous insufficiency: the San Diego Population Study. Thromb Res. 2012 Nov. 130(5):716-9. [Medline].
Carrasco OF, Ranero A, Hong E, Vidrio H. Endothelial function impairment in chronic venous insufficiency: effect of some cardiovascular protectant agents. Angiology. 2009 Dec-2010 Jan. 60(6):763-71. [Medline].
Coon WW, Willis PW 3rd, Keller JB. Venous thromboembolism and other venous disease in the Tecumseh community health study. Circulation. 1973 Oct. 48(4):839-46. [Medline].
Schultz-Ehrenburg U, Weindorf N, Matthes U, Hirche H. [An epidemiologic study of the pathogenesis of varices. The Bochum study I-III]. Phlebologie. 1992 Nov-Dec. 45(4):497-500. [Medline].
Chiesa R, Marone EM, Limoni C, Volonte M, Schaefer E, Petrini O. Chronic venous insufficiency in Italy: the 24-cities cohort study. Eur J Vasc Endovasc Surg. 2005 Oct. 30(4):422-9. [Medline].
Abbade LP, Lastoria S, Rollo Hde A. Venous ulcer: clinical characteristics and risk factors. Int J Dermatol. 2011 Apr. 50(4):405-11. [Medline].
Tsai S, Dubovoy A, Wainess R. Severe chronic venous insufficiency: magnitude of the problem and consequences. Ann Vasc Surg. 2005. 19:705-11.
Racette S, Sauvageau A. Unusual sudden death: two case reports of hemorrhage by rupture of varicose veins. Am J Forensic Med Pathol. 2005 Sep. 26(3):294-6. [Medline].
Evans GA, Evans DM, Seal RM, Craven JL. Spontaneous fatal haemorrhage caused by varicose veins. Lancet. 1973 Dec 15. 2(7842):1359-61. [Medline].
Casian D, Gutsu E, Culiuc V. Surgical treatment of severe chronic venous insufficiency caused by pulsatile varicose veins in a patient with tricuspid regurgitation. Phlebology. 2009 Apr. 24(2):79-81. [Medline].
Gasparis AP, Tsintzilonis S, Labropoulos N. Extraluminal lipoma with common femoral vein obstruction: a cause of chronic venous insufficiency. J Vasc Surg. 2009 Feb. 49(2):486-90. [Medline].
Bonnetblanc JM. Leg ulcerations: a clinical appraisal. Eur J Dermatol. 2005 May-Jun. 15(3):127-32. [Medline].
Morales-Cuenca G, Moreno-Egea A, Aguayo-Albasini JL. [General surgeons and varicose vein surgery]. Cir Esp. 2009 Apr. 85(4):205-13. [Medline].
Van den Berg PJ, Visser LH. Extra- and transcranial echo colour Doppler in the diagnosis of chronic cerebrospinal venous insufficiency. Phlebology. 2012 Mar. 27 Suppl 1:107-13. [Medline].
Lattimer CR, Azzam M, Kalodiki E, Makris GC, Geroulakos G. Saphenous pulsation on duplex may be a marker of severe chronic superficial venous insufficiency. J Vasc Surg. 2012 Nov. 56(5):1338-43. [Medline].
[Guideline] Gloviczki P, Comerota AJ, Dalsing MC, et al. The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 2011 May. 53(5 Suppl):2S-48S. [Medline].
Zhan HT, Bush RL. A review of the current management and treatment options for superficial venous insufficiency. World J Surg. 2014 Oct. 38(10):2580-8. [Medline].
Vanscheidt W, Ukat A, Partsch H. Dose-response of compression therapy for chronic venous edema--higher pressures are associated with greater volume reduction: two randomized clinical studies. J Vasc Surg. 2009 Feb. 49(2):395-402, 402.e1. [Medline].
Couzan S, Leizorovicz A, Laporte S, et al. A randomized double-blind trial of upward progressive versus degressive compressive stockings in patients with moderate to severe chronic venous insufficiency. J Vasc Surg. 2012 Nov. 56(5):1344-1350.e1. [Medline].
Ramos-Gonzalez E, Moreno-Lorenzo C, Mataran-Penarrocha GA, Guisado-Barrilao R, Aguilar-Ferrandiz ME, Castro-Sanchez AM. Comparative study on the effectiveness of myofascial release manual therapy and physical therapy for venous insufficiency in postmenopausal women. Complement Ther Med. 2012 Oct. 20(5):291-8. [Medline].
Nijsten T, van den Bos RR, Goldman MP, et al. Minimally invasive techniques in the treatment of saphenous varicose veins. J Am Acad Dermatol. 2009 Jan. 60(1):110-9. [Medline].
Zimmet SE. Venous leg ulcers: modern evaluation and management. Dermatol Surg. 1999 Mar. 25(3):236-41. [Medline].
Sadick NS. Advances in the treatment of varicose veins: ambulatory phlebectomy, foam sclerotherapy, endovascular laser, and radiofrequency closure. Dermatol Clin. 2005 Jul. 23(3):443-55, vi. [Medline].
Navarro TP, Nunes TA, Ribeiro AL, Castro-Silva M. Is total abolishment of great saphenous reflux in the invasive treatment of superficial chronic venous insufficiency always necessary?. Int Angiol. 2009 Feb. 28(1):4-11. [Medline].
Maksimovic ZV, Maksimovic M, Jadranin D, Kuzmanovic I, Andonovic O. Medicamentous treatment of chronic venous insufficiency using semisynthetic diosmin--a prospective study. Acta Chir Iugosl. 2008. 55(4):53-9. [Medline].
Tretbar LL. Treatment of small bleeding varicose veins with injection sclerotherapy. Bleeding blue blebs. Dermatol Surg. 1996 Jan. 22(1):78-80. [Medline].
Nael R, Rathbun S. Treatment of varicose veins. Curr Treat Options Cardiovasc Med. 2009 Apr. 11(2):91-103. [Medline].
Leopardi D, Hoggan BL, Fitridge RA, Woodruff PW, Maddern GJ. Systematic review of treatments for varicose veins. Ann Vasc Surg. 2009 Mar. 23(2):264-76. [Medline].
Husni EA. Reconstruction of veins: the need for objectivity. J Cardiovasc Surg (Torino). 1983 Sep-Oct. 24(5):525-8. [Medline].
Raju S, Neglen P. Stents for chronic venous insufficiency: why, where, how and when--a review. J Miss State Med Assoc. 2008 Jul. 49(7):199-205. [Medline].