Chronic Venous Insufficiency
Say good-bye to CVI—Keep the blood that flows from your
feet to your heart in constant motion. According to research or other evidence, the following
self-care steps may be helpful:
- Relieve vein strain
- Wear compression stockings to support veins affected by CVI
- Fill up on flavonoids
- Strengthen capillaries and veins by taking 1,000 mg of
hydroxyethylrutosides or 150 mg of proanthocyanidins daily
- Discover herbal therapy
- Relieve CVI symptoms by taking standardized extracts of either
horse chestnut (100 mg of aescin a day) or butcher’s broom (15 mg of ruscogenins a
These recommendations are not comprehensive and are not intended to replace
the advice of your doctor or pharmacist. Continue reading the full chronic venous
insufficiency article for more in-depth, fully-referenced information on medicines, vitamins,
herbs, and dietary and lifestyle changes that may be helpful.
About chronic venous insufficiency
Chronic venous insufficiency (CVI) is poor return of blood from feet and legs back to the
CVI may occur following excessive clotting and inflammation of the leg veins, a disease
known as deep vein thrombosis. CVI also results from a simple failure of the valves in leg
veins to hold blood against gravity, leading to sluggish movement of blood out of the veins,
resulting in swollen legs.
Product ratings for chronic
What are the symptoms?
CVI may cause feet and calves to become swollen, often accompanied by a dull ache made
worse with prolonged standing. If CVI is allowed to progress, the skin tends to darken and
ulcers may occur. CVI often causes varicose
Over-the-counter antibiotic products that
contain bacitracin (Baciguent), neomycin
(Myciguent), a combination of bacitracin and polymyxin B (Polysporin), or a combination of all
three (Neosporin) might be useful if skin ulcers develop.
Topical prescription antibiotics such as mupirocin (Bactroban) and metronidazole (MetroGel) may be useful for the
treatment of skin ulcers.
Healthcare practitioners typically advise patients to elevate the legs frequently, avoid
prolonged standing or sitting, and wear graduated compression stockings with supportive shoes.
Recurrent ulceration may be surgically treated with skin grafts. Surgical repair or bypass of
the affected veins is sometimes necessary.
Lifestyle changes that may be helpful
People affected by chronic venous insufficiency should not sit or stand for long periods of
time. When sitting, they should elevate their legs. Walking helps move blood out of the veins.
Wearing tight-fitting compression stockings available from pharmacies further supports the
Vitamins that may be helpful
Flavonoids promote venous strength and
integrity. Most trials of flavonoids in patients with CVI have used a type of flavonoid called
hydroxyethylrutoside (HR), which is derived from rutin. These double-blind and other
controlled trials have consistently shown a beneficial effect of HR in clearing leg swelling
and other signs of CVI.1 2 3 Positive results from a
double-blind trial have been obtained using 500 mg of HR taken twice per day for 12
weeks.4 In this trial, the preparation was found to add further benefit to that
provided by compression stockings commonly used to treat CVI. Similar results were obtained in
another controlled trial.5 It is unclear whether other flavonoids are as effective
as HR for CVI. HR has also been used successfully as a topical preparation for the treatment
Proanthocyanidins (OPCs), a group of
flavonoids found in pine bark, grape seed,
grape skin, bilberry, cranberry, black currant, green tea, black tea, and other plants, have also been shown to
strengthen capillaries in double-blind research using as little as two 50 mg tablets per
day.7 In a double-blind trial using a total of 150 mg OPCs per day, French
researchers reported reduced symptoms for women with CVI.8 In another French
double-blind trial, supplementation with 100 mg taken three times per day resulted in benefits
within four weeks.9
Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.
Herbs that may be helpful
According to an extensive overview of clinical trials, standardized horse chestnut seed extract, which contains the active
compound aescin, has been shown to be effective in double-blind and other controlled research,
supporting the traditional use of horse chestnut for venous problems.10 In these
trials, capsules of horse chestnut extract containing 50 mg of aescin were given two to three
times daily for CVI. The positive effect results in part from horse chestnut’s ability
to strengthen capillaries, which leads to a reduction in swelling.11
Another traditional remedy for CVI is
butcher’s broom. One double-blind trial used a combination of butcher’s broom,
the flavonoid hesperidin, and vitamin C. This was found to be better than a placebo
for treating CVI.12 In a comparison study, a product combining butcher’s
broom extract, the flavonoid hesperidin, and vitamin C was more effective than a synthetic
flavonoid product for treating CVI.13 A double-blind study, in which Butcher's
broom alone was used, has confirmed the beneficial effect of this herb.14 Clinical
trials have used one capsule, containing standardized extracts providing 15 to 30 mg of
ruscogenins, three times each day. The amount of butcher’s broom extract used in these
trials is 150 mg two times per day. Other sources recommend standardized extracts providing 15
to 30 mg of ruscogenins, given three times each day.
Gotu kola extracts, standardized to
triterpenoid content, have been found successful in small preliminary trials to treat
CVI.15 The amount of extract used in these trials ranged from 60 to 120 mg per
A double-blind trial demonstrated that red vine leaf extract is effective at relieving the
symptoms and swelling associated with CVI.16 One group of participants took either
360 mg or 720 mg per day of a standardized extract for 12 weeks, and another group took a
placebo. At the end of the treatment period, those who had taken the herb experienced
significant improvement in symptoms of leg heaviness, tension sensation, tingling, and pain
compared with those who had taken the placebo. Objective measurements of leg swelling were
also significantly improved in the red vine group compared to the placebo group.
Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.
1. 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
2. Bergqvist D, Hallbook T, Lindblad B, Lindhagen A. A double-blind trial
of O-(s-hydroxyethyl)-rutoside in patients with chronic venous insufficiency. Vasa
3. Poynard T, Valterio C. Meta-analysis of hydroxyethylrutosides in the
treatment of chronic venous insufficiency. Vasa 1994;23:244–50.
4. Unkauf M, Rehn D, Klinger J, et al. Investigation of the efficacy of
oxerutins compared to placebo in patients with chronic venous insufficiency treated with
compression stockings. Arzneimittelforschung 1996;46:478–82.
5. Neumann HA, van den Broek MJ. A comparative clinical trial of
graduated compression stockings and O-(beta-hydroxyethyl)-rutosides (HR) in the treatment of
patients with chronic venous insufficiency. Z Lymphol 1995;19:8–11.
6. Frick RW. Three treatments for chronic venous insufficiency: escin,
hydroxyethylrutoside, and Daflon. Angiology 2000;51:197–205 [review].
7. Dartenuc JY, Marache P, Choussat H. Resistance Capillaire en Geriatrie
Etude d’un Microangioprotecteur. Bordeax Médical 1980;13:903–7 [in
8. Delacroix P. Etude en Double Avengle de l’Endotelon dans
l’Insuffisance Veineuse Chronique. Therapeutique, la Revue de Medicine
1981;Sept 27–28:1793–1802 [in French].
9. Thebaut JF, Thebaut P, Vin F. Study of Endotelon in functional
manifestations of peripheral venous insufficiency. Gazette Medicale
1985;92:96–100 [in French].
10. Pittler MH, Ernst E. Horse-chestnut seed extract for chronic venous
insufficiency: a criteria-based systematic review. Arch Dermatol
11. 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;111:1321–9 [in German].
12. Cappelli R, Nicora M, Di Perri T. Use of extract of Ruscus aculeatus
in venous disease in the lower limbs. Drugs Exp Clin Res 1988;14:277–83.
13. Beltramino R, Penenory A, Buceta AM. An open-label, randomized
multicenter study comparing the efficacy and safety of Cyclo 3 Fort® versus hydroxyethyl
rutoside in chronic venous lymphatic insufficiency. Angiology
14. Vanscheidt W, Jost V, Wolna P, et al. Efficacy and safety of a
Butcher's broom preparation (Ruscus aculeatus L. extract) compared to placebo in patients
suffering from chronic venous insufficiency. Arzneimittelforschung
15. Brinkhaus B, Linder M, Schuppan D, Hahn EG. Chemical, pharmacological
and clinical profile of the East Asian medical plant Centella asiatica. Phytomedicine
16. Kiesewetter H, Koscielny J, Kalus U, et al. Efficacy of orally
administered extract of red vine leaf AS 195 (folia vitis viniferae) in chronic
venous insufficiency (stages I-II). A randomized, double-blind, placebo-controlled trial.