Gloviczki Monika Lecomte, Kakkos Stavros K, Urbanek Tomasz, Chuback John, Nicolaides Andrew
Department of Internal Medicine and Gonda Vascular Center, Mayo Clinic, Rochester, MN; Vascular Science & Art, LLC, Scottsdale, AZ.
Department of Vascular Surgery, University of Patras Medical School, Patras, Greece.
J Vasc Surg Venous Lymphat Disord. 2025 May 8;13(5):102258. doi: 10.1016/j.jvsv.2025.102258.
Chronic venous disease (CVD) is a major global health issue, affecting millions of people and contributing to significant morbidity and economic strain. The condition's pathophysiology is complex, involving both mechanical and biochemical processes that lead to venous reflux, obstruction, and chronic inflammation. This review focuses on the role of venoactive compounds (VACs), also known as venoactive drugs in Europe and other parts of the world, in managing CVD. The aim was to review the scientific evidence and to define the role of VACs within the comprehensive treatment algorithm for CVD, alongside established and well adopted interventional therapies and noninterventional therapies such as compression.
The review of the scientific evidence was done on VACs mechanism of action and efficacy in alleviating CVD symptoms, reducing swelling or venous edema, and improving healing of venous leg ulcers. Whenever available, systematic reviews, meta-analyses and randomized controlled trials were used. The quality of evidence assessment followed the GRADE methodology from A (high), B (moderate), to C (low to very low) quality.
Venoactive drugs or compounds share similar effects, such as sealing the endothelial barrier, enhancing lymphatic drainage, reducing edema, improving venous tone, inhibiting leukocyte adhesion to vein walls/valves and inflammatory mediator release, lowering blood viscosity, and promoting red blood cell flexibility. Scientific evidence on the VACs effectiveness on CVD symptoms (pain, cramps, and heaviness) and swelling or edema have shown some variability. Micronized purified flavonoid fraction (MPFF) and Ruscus extract combined with hesperidin methyl chalcone and ascorbic acid had the highest, mostly level A, quality of evidence. In venous leg ulcers, micronized purified flavonoid fraction, sulodexide, and pentoxifylline were the most effective adjunctive treatments, with evidence level A.
The existing scientific evidence provides a strong rationale for incorporating VACs into a comprehensive treatment plan for CVD, alongside established interventional therapies and noninterventional approaches like compression, to optimize patient outcomes and improve quality of life.
慢性静脉疾病（CVD）是一个重大的全球健康问题，影响着数百万人，并导致严重的发病率和经济负担。该疾病的病理生理学很复杂，涉及导致静脉反流、阻塞和慢性炎症的机械和生化过程。本综述聚焦于血管活性化合物（VACs，在欧洲和世界其他地区也被称为血管活性药物）在CVD管理中的作用。目的是回顾科学证据，并确定VACs在CVD综合治疗方案中的作用，以及与已确立且广泛应用的介入治疗和非介入治疗（如压迫治疗）的关系。
对VACs的作用机制以及在缓解CVD症状、减轻肿胀或静脉水肿、促进下肢静脉溃疡愈合方面的疗效进行了科学证据综述。只要有可用的，就使用系统评价、荟萃分析和随机对照试验。证据质量评估遵循从A（高）、B（中）到C（低至极低）质量的GRADE方法。
血管活性药物或化合物具有相似的作用，如封闭内皮屏障、增强淋巴引流、减轻水肿、改善静脉张力、抑制白细胞黏附于静脉壁/瓣膜以及炎症介质释放、降低血液黏度和促进红细胞柔韧性。关于VACs对CVD症状（疼痛、痉挛和沉重感）以及肿胀或水肿有效性的科学证据存在一定差异。微粉化纯化黄酮类成分（MPFF）以及与橙皮苷甲基查耳酮和抗坏血酸联合使用的假叶树提取物具有最高的证据质量，大多为A级。在下肢静脉溃疡方面，微粉化纯化黄酮类成分、舒洛地特和己酮可可碱是最有效的辅助治疗药物，证据级别为A级。
现有科学证据为将VACs纳入CVD综合治疗方案提供了有力依据，与已确立的介入治疗和压迫等非介入方法一起，以优化患者预后并改善生活质量。
