We aimed to assess the efficacy of Centella asiatica for improvement of the signs and symptoms of chronic venous insufficiency (CVI). We searched 13 electronic databases including the Cochrane Central Register of Controlled Trials for randomised controlled trials assessing the efficacy of Centella asiatica for CVI. Two review authors independently selected studies, assessed the risks of bias of included studies and extracted data. The treatment effects of similar studies were pooled whenever appropriate. Eight studies met the inclusion criteria. The pooling of data of similar studies showed that Centella asiatica significantly improved microcirculatory parameters such as transcutaneous partial pressure of CO2 and O2, rate of ankle swelling and venoarteriolar response. Three out of the eight studies did not provide quantitative data. However, these studies reported that patients treated with Centella asiatica showed significant improvement in CVI signs such as leg heaviness, pain and oedema. Our results show that Centella asiatica may be beneficial for improving signs and symptoms of CVI but this conclusion needs to be interpreted with caution as most of the studies were characterised by inadequate reporting and thus had unclear risks of bias, which may threaten the validity of the conclusions.
Rutoside (rutin; quercetin rutinoside) is a glycoside found in various plant products, including apples, citrus fruits and cranberries. Hydroxyethylrutosides (HR) are semisynthetic derivatives sold as standardized products for the treatment of chronic venous insufficiency (CVI). Commercially available products include Relvène(®) (France), Venoruton(®) (Switzerland) and Paroven(®) (United Kingdom). However, the evidence for their efficacy is inconclusive. The aim of this systematic review was to evaluate the evidence of efficacy and tolerability of hydroxyethylrutosides for CVI.
Isolated distal deep vein thrombosis (IDDVT) is presumed to be more benign than proximal DVT (PDVT) or pulmonary embolism (PE), suggesting a need for different management approaches. This subgroup analysis of the RE-COVERY DVT/PE global, observational study investigated patient characteristics, hospitalization details, and anticoagulant therapy in patients with IDDVT in real-world settings in 34 countries enrolled from January 2016 to May 2017. Data were analyzed descriptively according to the type and location of the index venous thromboembolism (VTE): IDDVT, PDVT ± distal DVT (DDVT), and PE ± DVT. Of the 6,095 eligible patients, 323 with DVT located outside the lower limb and no PE were excluded. Of the remaining 5,772 patients, 17.6% had IDDVT, 39.9% had PDVT ± DDVT, and 42.5% had PE ± DVT. IDDVT patients were younger and had fewer risk factors for VTE than the other groups. Other comorbidities were less frequent in the IDDVT group, except for varicose veins, superficial thrombophlebitis, and venous insufficiency. IDDVT patients were less likely to be diagnosed in an emergency department (22.3 vs. 29.7% for PDVT ± DDVT and 45.4% for PE ± DVT) or hospitalized for VTE (29.2 vs. 48.5% for PDVT ± DDVT and 75.0% for PE ± DVT). At hospital discharge or 14 days after diagnosis (whichever was later), non-vitamin K antagonist oral anticoagulants were the most commonly used anticoagulants (55.6% for IDDVT, 54.7% for PDVT ± DDVT, and 52.8% for PE ± DVT). Although differences in patient characteristics, risk factors, and clinical management were identified, anticoagulant treatment of IDDVT was almost equal to that of PDVT or PE. Prospective studies should investigate whether, in a global perspective, this is an appropriate use of anticoagulants. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT02596230.
AIM: Chronic venous ulcers usually occur as an occupational hazard due to venous insufficiency with venous hypertension. Endovenous laser treatment (EVT) is used to treat varicose veins with venous ulcers and outcome including demography assessed in the different races.
PROCEDURE: 145 lower limbs(right 39.3%, left 60.7%) with venous ulcers involving reflux of the great saphenous (132 cases) and / or small saphenous (57 cases) veins underwent EVT with 980 nm diode laser for single (123 cases) or both (11 cases) legs intervention. Supplementary procedures required multiple avulsions and / or sclerotherapy. Holistic advice of multilayered bandaging, graduated compression stockings, weight reduction and lifestyle changes enforced.
RESULT: The average age with venous ulcers was 53.6 years.The mean BMI was 26.8 : the Chinese, Indian and Malay BMIs were 25.1, 28.1 and 31.3 respectively. Symptoms that included pain, swelling, heaviness and cramps assessed pre- and postsurgically were significantly reduced (<0.0001), using the Wilcoxan signed rank test. Of the occupations involved by race, the Chinese were mostly salespersons, Indians blue collar workers and Malays foodrelated workers. Young overweight Indians with sedentary occupations were most predisposed to venous ulcers. Gram negative organisms 63.4% and gram positive organisms 36.6% were isolated in the ulcers. Most ulcers 63.5% measured <2 cm and majority 73.8% localised in the gaiter area.
DISCUSSION: Results of EVT in healing ulcers with no recurrences more than 2 years were successful in 89.7% (130/145). Complications included numbness foot 7.5% and DVT 1.4%. 10.3% (15 cases) had recurrence of venous ulcers within 2 years. In terms of satisfaction 32.3% experienced as very satisfied while 63.4% were satisfied and 4.3% unsatisfied. In conclusion EVT is a useful adjunct with with minimal invasion in managing venous ulcers holistically.