a Savelyev University Surgical Clinic , Pirogov Russian National Research Medical University , Moscow , Russia.
b City Clinical Hospital No.1 named after N.I. Pirogov , Moscow , Russia.
Curr Med Res Opin. 2019 Jun;35(6):1019-1026. doi: 10.1080/03007995.2018.1552043. Epub 2018 Dec 20.
Concomitant varicose veins of the pelvis (VVP) and lower extremities (VVLE) frequently coexist. This study evaluated the effectiveness and safety of micronized purified flavonoid fraction (MPFF) in the treatment of patients with both conditions.
Female outpatients with concomitant VVP and VVLE received MPFF 1000 mg once daily for 2 months (Group 1), or 1000 mg twice daily for 1 month followed by 1000 mg once daily for 1 month (Group 2), based on pelvic pain intensity. Change in pain intensity during treatment was evaluated on a 10 cm visual analog scale. All patients underwent transvaginal and transabdominal duplex ultrasound scanning, radionuclide phlebography of the lower extremities, and emission computer tomography of the pelvic veins at inclusion and end of treatment.
In Group 1 (N = 35), MPFF was associated with a twofold reduction in pain syndrome severity (pelvic, perineal and lower leg pain) in all patients after 1 month, and a reduction in chronic pelvic pain (CPP) from 3.4 ± 1.2 to 0.83 ± 0.18 cm at 2 months. Leg pain significantly decreased from 2.8 ± 0.6 at baseline to 0.94 ± 0.11 after 2 months. In Group 2 (N = 30), MPFF decreased CPP severity from 6.3 ± 0.8 to 1.2 ± 0.12, perineal pain from 3.6 ± 0.9 to 0.88 ± 0.22 and leg pain from 4.6 ± 0.5 to 0.9 ± 0.1. Radionuclide phlebography confirmed the clinical improvement in both treatment groups, with a substantial increase in linear blood flow velocity in the internal iliac veins (∼10% in Group 1 and 35% in Group 2) and a reduction in mean transit times of the radiopharmaceutical. MPFF also reduced blood stasis in the pelvic venous plexuses. Gastralgias were reported in two patients but resolved rapidly and did not lead to treatment withdrawal.
Phlebotropic treatment with MPFF is an effective and safe method of conservative therapy in patients with concomitant VVP and VVLE.
盆腔（VVP）和下肢（VVLE）静脉曲张常同时存在。本研究评估了微粉化纯化黄酮类混合物（MPFF）治疗这两种病症的有效性和安全性。
患有 VVP 和 VVLE 的女性门诊患者根据盆腔疼痛强度，每日接受 MPFF 1000mg 一次（第 1 组）或每日两次 1000mg 治疗 1 个月，然后改为每日一次 1000mg 治疗 1 个月（第 2 组）。治疗期间，通过 10cm 视觉模拟量表评估疼痛强度的变化。所有患者在入组和治疗结束时均接受经阴道和经腹双功能超声扫描、下肢放射性核素静脉造影和盆腔静脉发射型计算机断层扫描。
第 1 组（N=35）中，MPFF 治疗 1 个月后，所有患者的疼痛综合征严重程度（盆腔、会阴和小腿疼痛）均降低两倍，慢性盆腔疼痛（CPP）从 3.4±1.2cm 降低至 2 个月时的 0.83±0.18cm；腿部疼痛从基线时的 2.8±0.6cm 显著降低至 2 个月时的 0.94±0.11cm。第 2 组（N=30）中，MPFF 治疗后 CPP 严重程度从 6.3±0.8cm 降低至 1.2±0.12cm，会阴疼痛从 3.6±0.9cm 降低至 0.88±0.22cm，腿部疼痛从 4.6±0.5cm 降低至 0.9±0.1cm。放射性核素静脉造影证实了两组的临床改善，髂内静脉内线性血流速度显著增加（第 1 组约为 10%，第 2 组为 35%），放射性药物平均通过时间缩短。MPFF 还减少了盆腔静脉丛的血液淤滞。有两名患者报告出现胃痛，但很快缓解，并未导致停药。
MPFF 的静脉活性治疗是治疗同时患有 VVP 和 VVLE 的患者的一种有效且安全的保守治疗方法。
