Variations in Plasma Free Radicals with Topical Aescin + Essential Phospholipids Gel in Venous Hypertension: New Clinical Data

Comparative evaluation of the effectiveness of phlebotonic gels

Introduction. Varicose veins are a common disease with a chronic course and a high risk of complications and cosmetic defects. Venotonic drugs are widely used in conservative treatment of varicose veins.

Aim. To study the comparative efficacy of venotonic drugs for local application in experimental conditions.

Materials and Methods. Varicose veins were modeled in Wistar rats by partial stricture of the deep femoral vein. The studied drugs were applied in the course of 14 days from the operation. The assessed parameters were the change of local blood flow velocity in the skin in the dynamics and the degree of vascular permeability. The rate of local blood flow was assessed by Doppler ultrasound. Changes in vascular permeability were studied by the degree of extravasation of Evans blue dye in the Miles test. The results were processed using the methods of variation statistics.

Results. The study showed that under the conditions of experimental chronic venous insufficiency, a course of application of all the analyzed drugs resulted in an increase in the rate of local blood flow in the skin and a decrease in the degree of vascular permeability. It was noted that application of the investigated gel based on escin, heparin and essential phospholipids to the skin of animals resulted in reliably (p < 0,05) lower indices of vascular permeability in comparison with the rats which received a course therapy with the heparin-containing gel; combined cosmetic agent as well as the gel based on troxerutin, heparin and dexpanthenol.

Discussion. The results obtained testify that application of external dosage forms of combined venotonic drugs promotes the regression of chronic venous insufficiency manifestations. Maximum evident effect was registered while applying the studied drug, that can be related to its complex composition including essential phospholipids, heparin and aescin. It is known that aescin is a phlebotonic with a high degree of percutaneous absorption, the effect of which is significantly potentiated by the phospholipid component.

Conclusions. The application of the combined product based on heparin, aescin and essential phospholipids provided an optimum rate of onset of pharmacological effect compared to the other analysed compositions.

A Review of the Microcirculation in Skin in Patients With Chronic Venous Insufficiency: The Problem and the Evidence Available for Therapeutic Options

Impairment of the cutaneous microcirculation is a major predisposing factor in inflammation and ulceration in patients with chronic venous insufficiency (CVI). Increase of capillary filtration rate predisposes to the formation of edema. Local lymphedema is a complication of CVI, often underdiagnosed. This review is focused on CVI but excludes the complication of ulceration. Treatment of microcirculatory dysfunction can be done by pharmacologic intervention or compression therapy or using a combination of both. This review is focused on drugs that have been evaluated by randomized prospective controlled trials. The following compounds are discussed: horse chestnut seed extracts, flavonoids, red vine leaves extracts, total triterpenic fraction of Centella asiatica (L), prociadins, calcium dobesilate, and pentoxifylline. The microcirculatory effects of compression therapy using bandages or stockings are also reviewed. The major microcirculatory effects that have been shown are the reduction of capillary filtration rate and improvements in levels of transcutaneous partial pressures of oxygen and carbon dioxide (TcPO2 and TcPCO2). Available data suggest that a combination of pharmacologic and compression therapy may have some additive effects.