Chronic Venous Insufficiency and Varicose Vein Remedies
Surgery May NOT Be Necessary

Chronic venous insufficiency (CVI) is a leg vein problem that causes many years of increasing pain and disability for many thousands of people, the majority of them women. Arteries bring oxygenated blood from your heart to the rest of your body. Veins return oxygen-deficient blood back to your heart. CVI occurs when the veins are unable to pump enough blood back to your heart. CVI is commonly referred to as chronic venous disease, or CVD.

What causes CVI?

Long-term blood pressure that is higher than normal inside your leg veins is the most common cause of CVI. The blood flowing through your leg veins must work against gravity to return to your heart. Your leg muscles squeeze the deep veins in your legs and lower extremities to help move blood back up to your heart. One-way valves in your deep veins ensure that blood keeps flowing in the right direction. When you relax your leg muscle valves close whereby preventing the blood from flowing backward.

When you walk or exercise your leg muscles squeeze assisting the flow of blood back to the heart. However, when you sit, stand or relax for long periods of time, the blood in your leg veins can pool and increase blood pressure. The veins in your legs can usually withstand short periods of increased pressure but long periods of pressure can stretch vein walls. Over time, in susceptible individuals, this can seriously weaken leg vein walls and valves, causing chronic venous insufficiency.

Other causes of CVI include deep vein thrombosis (DVT) and phlebitis. Both of these conditions elevate blood pressure in leg veins that can lead to CVI.

DVT occurs when a thrombus (blood clot) stops blood from flowing freely through deep veins in the legs. Blood that builds up behind a thrombus increases pressure on the vein walls and may stretch vein values, whereby rendering them ineffective. Damaged vein valves that no longer work efficiently may contribute to CVI.

Phlebitis is a condition where the superficial veins in the legs becoming inflamed or swollen. This inflammation and swelling causes blood clotting, which in a similar manner to DVT, can lead to CVI.

CVI can also results from a simple failure of the leg vein values to hold blood against gravity, leading to slow movement of blood out of the veins, resulting in thick, swollen legs.

Although CVI can affect anyone, individuals with a family history of varicose veins are most susceptible. Other factors that can increase the risk of CVI include pregnancy, obesity, smoking, standing or sitting for long periods of time and not getting enough exercise. Both age and sex are also factors that can increase your risk of CVI.

Supplements may be helpful.

Supplements that promote vein strength and integrity can be beneficial for individuals susceptible to CVI. Flavonoids (rutin) and horse chestnut extract show the most promise for helping to control the symptoms of CVI. Other vein strengthening supplements that may also be helpful include butcher’s broom, gotu kola and another group of flavonoids called proanthocyanidins.

Many trials that have studied the affects of flavonoids in relation to CVI have used hydroxyethylrutoside (HR), a derivative of rutin – a flavonoid believed to be helpful for strengthening capillaries and managing venous edema (excessive accumulation of fluid in the veins). A number of double-blind trials have shown HR to be beneficial in helping to clear leg swelling as well as other signs of CVI.

Oxerutins, another derivative of rutin, have been widely used in Europe since the mid-1960s in connection with CVI but this supplement remains hard to find in North America. Oxerutins were specifically developed to treat varicose veins and related venous problems. However, it is still not clear whether this particular derivative of rutin is more effective than other bioflavonoids used for these conditions. Oxerutins are closely related to the natural flavonoid rutin, which is found primarily in citrus fruits and buckwheat.

Two double-blind, placebo-controlled studies suggest that buckwheat tea might also be effective against varicose veins and CVI, presumably because of its rutin content.

Horse chestnut seed extract is widely used in Europe for chronic venous insufficiency (CVI). Although traditionally recommended for a variety of medical conditions, CVI is the only condition for which there is strong supportive scientific evidence for the benefit of horse chestnut seed extract. More than 800 individuals have bee involved in double-blind, placebo-controlled studies of horse chestnut for treating venous insufficiency. In one study, using a crossover design, 212 participants were given either horse chestnut or a placebo. Results of the 60 day study showed that horse chestnut significantly reduced leg edema, pain, and heaviness when compared to the placebo.

Analysis of the results of other double-blind and controlled trials show that standardized horse chestnut seed extract, which contains aescin, is effective for CVI. Most trials used capsules of horse chestnut extract containing 50 mg of aescin and were administered 2 to 3 times a day. The primary effect observed in these trials was a strengthening of capillaries, which lead to a reduction in swelling.

While the exact mechanism responsible for horse chestnut’s beneficial effects with CVI is unknown it is believed that the herb’s primary active ingredient, aescin, plays a key role. The prominent theory is that aescin reduces the rate of fluid leakage from stressed and irritated vessel walls by preventing the release of enzymes that break down collage and open holes in capillary walls, and by forestalling other forms of vein damage.

Butcher’s broom is another herb that may be useful for individuals with CVI. In Europe it has even been approved by Germany's Commission E as a supportive therapy for chronic venous insufficiency. The results of one double-blind study examined the effectiveness of standardized butcher’s broom extract in 166 women with CVI. Study participants were given butcher’s broom (one tablet twice daily containing 36.0 to 37.5 mg of a methanol dry extract concentrated at 15-20:1) or a placebo for a period of 3 months. The results of the study showed that leg swelling decreased significantly in the group of participants who were given butcher’s broom when compared to the placebo group.

Other studies have also indicated that standardized gotu kola extracts may be helpful for people suffering from CVI. Preliminary double-blind, placebo-controlled studies indicate that gotu kola extract may provided improvement in major venous insufficiency symptoms, reducing swelling, pain, fatigue, sensation of heaviness and fluid leakage from the veins.

Suggested Dosage

A suggested dosage of standardized* horse chestnut is 300 milligrams every 12 hours, for up to 12 weeks (containing 50 to 75 milligrams of escin per dose). A dose of 600mg of chestnut seed extract per day has also been studied.

The usual dosage of gotu kola is 20 to 60 mg 3 times daily of an extract standardized to contain 40 asiaticoside, 29 to 30 asiatic acid, 29 to 30 madecassic acid, and 1 to 2 madecassoside. When using it for venous insufficiency, give gotu kola at least 4 weeks to work. However, some researchers have suggested doses up to 120 mg per day.

*Standardization involves measuring the amount of certain chemicals in products to try to make different preparations similar to each other. It is not always known if the chemicals being measured are the active ingredients. Horse chestnut seed extract (HCSE) products are often standardized to contain 16 to 20 triterpene glycosides calculated as escin (aescin) content. --

Supporting Literature

Alter H. Medication therapy for varicosis [translated from German]. Z Allgemeinmed. 1973;49:1301–1304.

Bergqvist D, Hallbook T, Lindblad B, Lindhagen A. A double-blind trial of O-(s-hydroxyethyl)-rutoside in patients with chronic venous insufficiency. Vasa 1981;10:253–260.

Bisler H, Pfeifer R, Klüken N, Pauschinger P. Effects of horse-chestnut seed extract on transcapillary filtration in chronic venous insufficiency. Deutche Med Wochenschr 1986;111:1321–1329.

Brinkhaus B, Linder M, Schuppan D, Hahn EG. Chemical, pharmacological and clinical profile of the East Asian medical plant Centella asiatica. Phytomedicine 2000;7:427–448.
Bougelet C, Roland IH, Ninane N, et al. Effect of aescine on hypoxia-induced neutrophil adherence to umbilical vein endothelium. Eur J Pharmacol. 1998;345:89–95.

Clement DL. Management of venous edema: insights from an international task force. Angiology. 2000; 51:13-17.

Friederich HC, Vogelsberg H, Neiss A. Evaluation of internally effective venous drugs [translated from German]. Z Hautkr. 1978;53:369–374.

Ihme N, Kiesewetter H, Jung F, et al. Leg oedema protection from a buckwheat herb tea in patients with chronic venous insufficiency: a single-centre, randomised, double-blind, placebo-controlled clinical trial. Eur J Clin Pharmacol. 1996;50:443–447.

Koscielny J, Radtke H, Hoffmann KH, et al. Fagorutin buckwheat herb tea in chronic venous insufficiency [translated from German]. Z Phytother. 1996;17:147–150, 153–156, 159.

Kreysel HW, Nissen HP, Enghofer E. A possible role of lysosomal enzymes in the pathogenesis of varicosis and the reduction in their serum activity by Venostasin. Vasa. 1983;12:377–382.

Lohr E, Garanin G, Jesau P, et al. Anti-edemic therapy in chronic venous insufficiency with tendency to formation of edema [translated from German]. Munch Med Wochenschr 1986;128:579–581.

MacLennan WJ, Wilson J, Rattenhuber V, et al. Hydroxyethylrutosides in elderly patients with chronic venous insufficiency: its efficacy and tolerability. Gerontology. 1994; 40:45-52.
Neiss A, Bohm C. Demonstration of the effectiveness of the horse-chestnut-seed extract in the varicose syndrome complex [translated from German]. MMW Munch Med Wochenschr. 1976;118:213–216.

Pittler MH, Ernst E. Horse-chestnut seed extract for chronic venous insufficiency: a criteria-based systematic review. Arch Dermatol 1998;134:1356–1360.

Poynard T, Valterio C. Meta-analysis of hydroxyethylrutosides in the treatment of chronic venous insufficiency. Vasa 1994;23:244–250.

Rehn D, Brunnauer H, Diebschlag W, Lehmacher W. Investigation of the therapeutic equivalence of different galenical preparations of O-(s-hydroxyethyl)-rutosides following multiple dose per oral administration. Arzneimittelforschung 1996;46:488–492.

Steiner M, Hillemanns HG. Investigation of the anti-edemic efficacy of Venostatin [translated from German]. Munch Med Wochenschr. 1986;128:551–552.

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