Cilostazol for intermittent claudication.
Cilostazol has been shown to improve walking distance in people with intermittent claudication.PubMed 34192807 ↗
Open Source Apothecary At Home / Heart and circulation
Varicose veins and venous insufficiency
Horse chestnut has real trial evidence here, and it is one of the few herbs with a regulatory approval somewhere for the indication.
remedyChronic venous insufficiency is the leg-vein condition behind heaviness, aching, swelling, skin change and eventually ulceration. The best-supported plant preparation is horse chestnut seed extract, whose active is aescin.
Horse chestnut has multiple randomised trials showing reduction in leg pain, heaviness and swelling, and pooled analyses support it. It is licensed in some countries as a treatment for chronic venous insufficiency, which is unusual for a herb and reflects the trial base. The cautions are real: it interacts with antiplatelets and anticoagulants and can increase bleeding; the raw seed is toxic and only standardised extracts are safe to use; and it can cause GI upset, dizziness and headache.
The mechanical measures matter more than the capsule. Compression stockings are the mainstay — they work by opposing the venous pressure, and they have to be properly fitted and actually worn. Leg elevation, avoiding prolonged standing, exercise (walking uses the calf muscle pump), and skin care. A venous ulcer needs medical care and compression therapy, not a cream.
What else is used. Diosmin/hesperidin (a citrus flavonoid combination) has trials and is used medically in Europe. Gotu kola has small trials. Grape seed extract and pine bark extract (pycnogenol) have small trials showing reduced edema. All of these are modest.
Intermittent claudication is a different disease and a dangerous one to confuse. Narrowed arteries rather than leaky veins: pain on walking that eases with rest, cold pale feet, and a risk of limb loss. The treatment is exercise therapy, risk-factor control, and sometimes revascularisation — not a vein herb. A person with leg pain on walking should be assessed before treating it as a vein problem.
What the studies found
Rutosides for treatment of post-thrombotic syndrome.
Ten reports of nine studies were identified following searching and three studies with a total of 233 participants met the inclusion criteria.PubMed 30406640 ↗
Exercise training for intermittent claudication.
Supervised treadmill exercise significantly improves treadmill walking performance in people with PAD by approximately 180 meters compared with no exercise.PubMed 28874320 ↗
Rutosides for treatment of post-thrombotic syndrome.
There was no evidence that rutosides were superior to the use of placebo or ECS.PubMed 26376212 ↗
Exercise for intermittent claudication.
Exercise programmes are of significant benefit compared with placebo or usual care in improving walking time and distance in people with leg pain from IC who were considered to be fit for exercise intervention.PubMed 25037027 ↗
Preparation
Horse chestnut
- Standardised extract only — the raw seed and unstandardised preparations are toxic. Trials used about 50 mg of aescin twice daily.
- Check with a prescriber first: it interacts with anticoagulants and antiplatelets.
- Give it 4-8 weeks; GI upset, dizziness and headache are the reported effects.
Compression — the mainstay
- Graduated compression stockings, properly fitted by measurement, worn during the day
- Class 1 or 2 for most venous insufficiency; higher classes are prescribed
- Put them on before getting out of bed, when swelling is lowest
- Contraindicated if there is significant arterial disease — get assessed first
Leg care
- Elevate the legs above heart level for 20-30 minutes several times a day
- Walk regularly; the calf pump is what moves the blood
- Avoid prolonged standing still; shift weight or walk in place
- Moisturise the skin; treat any break in the skin seriously
Diosmin/hesperidin and gotu kola
- Standardised extracts per label; modest effects
- Used as adjuncts in several European countries
Grape seed and pine bark extract
- Small trials showing reduced leg edema; modest
If there is an ulcer
- Compression therapy and wound care, managed by a clinician or a specialist nurse. Not a salve.
Cautions and interactions
- Horse chestnut interacts with warfarin, DOACs and antiplatelets, and can cause bleeding.
- Raw horse chestnut seed is toxic. Only standardised extracts.
- Compression is contraindicated in significant arterial disease. Get the circulation assessed before using high compression.
- Do not apply a salve or essential oil to a venous ulcer.
When this is not a self-care problem — get help
- A leg that is suddenly swollen, hot, red and painful — possible deep vein thrombosis; urgent assessment.
- A leg that is pale, cold, painful and pulseless — arterial emergency; call emergency services.
- An open ulcer on the leg, spreading redness, or fever — medical assessment.
- Leg pain on walking that eases with rest — this is claudication, not a vein problem. Get assessed.
Known interactions
- Horse chestnut, diosmin, and grape seed/pine bark extracts: possible additive bleeding with anticoagulants and antiplatelets.
Related
Sources
- Cilostazol for intermittent claudication. The Cochrane database of systematic reviews 2021; doi:10.1002/14651858.CD003748.pub3 PubMed 34192807
- Rutosides for treatment of post-thrombotic syndrome. The Cochrane database of systematic reviews 2018; doi:10.1002/14651858.CD005625.pub3 PubMed 30406640
- Exercise training for intermittent claudication. Journal of vascular surgery 2017; doi:10.1016/j.jvs.2017.05.111 PubMed 28874320
- Rutosides for treatment of post-thrombotic syndrome. The Cochrane database of systematic reviews 2015; doi:10.1002/14651858.CD005625.pub3 PubMed 26376212
- Exercise for intermittent claudication. The Cochrane database of systematic reviews 2014; doi:10.1002/14651858.CD000990.pub3 PubMed 25037027