Rational therapy of chronic venous insufficiency--chances and limits of the therapeutic use of horse-chestnut seeds extract.

BACKGROUND AND METHODS: We report two clinical studies, one already published, performed in patients with early and advanced chronic venous insufficiency (CVI). In both, compression therapy and oral therapy with horse-chestnut seeds extracts (HCSE) were compared to placebo. RESULTS: The published study in early CVI (Grade I) showed HCSE and compression to be superior to placebo and to be equivalent to each other in reducing lower leg volume, a measure for oedema. In the study, in advanced CVI (Grade II and IIIa), compression appeared to be superior to placebo, whereas HCSE was not. HCSE fared better in Grade II than in Grade IIIa patients. These results are discussed in the light of data from an in vitro model, where HCSE has been able to close the intercellular gaps in the venular endothelium. Not fully specified factors lead to an opening of these gaps, resulting in oedema as well as in local coagulation and thrombosis. The subsequent inflammation keeps these gaps open and initiates and maintains a chronic disease process, which may be the starting point of CVI. CONCLUSION: Due to its ability to close the venular endothelial gaps, HCSE seems to be a suitable and protecting therapy during the early stages of CVI. In later more severe stages compression therapy is indicated. Taking into account the observed negative impact of compression on quality of life, pharmacological CVI therapy should start early to avoid progress and to spare patients compression therapy.

[Horse chestnut seed extract--an effective therapy principle in general practice. Drug therapy of chronic venous insufficiency]. / Rosskastaniensamenextrakt--ein wirksames Therapieprinzip in der Praxis.Medikamentöse Therapie der chronisch venösen Insuffizienz.

Within the framework of a case observation study involving more than 800 general practitioners, more than 5,000 patients with chronic venous insufficiency (CVI) were treated with standardised horse chestnut extract and followed up at regular intervals. The evolution of the symptoms, tolerability and adverse drug reactions were recorded. All of the symptoms investigated-pain, tiredness, tension and swelling in the leg, as well as itching and the tendency towards edema-all improved markedly or disappeared completely. The results of this study show that rational treatment with horse chestnut extract represents an economical, practice-relevant therapeutic "pillar", which in comparison with compression has the additional advantage of better compliance.