beta-escin and Venous-Insufficiency

Escin, hydroxyethylrutoside (HR), and Daflon have been shown to be safe and effective for the treatment of chronic venous insufficiency (CVI). They seem to work differently than compression therapy, suggesting that they would usefully augment this therapy. All three phlebotonics attenuate the drop in adenosine triphosphate in venous endothelial cells during hypoxia. This attenuates (1) the inflammation response, (2) the attraction of neutrophils, (3) damage to the veins, and (4) the release of growth factors. These factors otherwise would perpetuate venous insufficiency and contribute to varicose veins. Additional independent effects that would be useful for the treatment of CVI are that they reduce permeability and fragility; HR, Daflon, and perhaps escin increase venous tone; escin inhibits hyaluronidase; Daflon and probably HR are attracted to the veins. With regard to similarity, no differences in effect have been established among these phlebotonics.

Topics: Chronic Disease; Clinical Trials as Topic; Diosmin; Escin; Humans; Hydroxyethylrutoside; Venous Insufficiency

To assess the evidence for or against horse-chestnut seed extract (HCSE) as a symptomatic treatment of chronic venous insufficiency (CVI).. Computerized literature searches were performed in MEDLINE, EMBASE, BIOSIS, CISCOM, and the Cochrane Library (all from their respective institution to December 1996). The search terms were "horse chestnut," "Aesculus hippocastanum," "escin," and "Rosskastanie" (German for "horse chestnut"). There were no restrictions on the language of publication.. Double-blind, randomized controlled trials of oral HCSE for patients with CVI were included. Identifiers were removed from all publications before assessment.. Data were extracted in a standardized, predefined manner. Trial outcomes and the methodological quality of each trial were independently assessed by the 2 reviewers.. The superiority of HCSE is suggested by all placebo-controlled studies. The use of HCSE is associated with a decrease of the lower-leg volume and a reduction in leg circumference at the calf and ankle. Symptoms such as leg pain, pruritus, and a feeling of fatigue and tenseness are reduced. Five comparative trials against the reference medication indicate that HCSE and O-(beta-hydroxyethyl)-rutosides are equally effective. One trial suggests a therapeutic equivalence of HCSE and compression therapy. Adverse effects are usually mild and infrequent.. These data imply that HCSE is superior to placebo and as effective as reference medications in alleviating the objective signs and subjective symptoms of CVI. Thus, HCSE represents a treatment option for CVI that is worth considering.

Topics: Chronic Disease; Escin; Humans; Plant Extracts; Randomized Controlled Trials as Topic; Venous Insufficiency

On the basis of numerous pharmacological, clinical pharmacological and clinical investigations it could be proved, that Venostasin ret., standardized on 50 mg triterpenglycosides, calculated as escine, has effects on the venous system: It has tonical effects on the veins, decreases permeability and has protective and curative properties. The mechanism of action is not fully understood, although there are some new interesting biochemical aspects regarding the attenuation of lysosomal proteoglycan destructing enzymes, which are increasingly active in patients with chronic venal insufficiency. In several double-blind randomized cross-over studies it could be demonstrated, that subjective complaints are effectively diminished. As far as objective test variables are concerned (edema), the clinical effectiveness could be shown on the basis of exact biometrical investigations. Thus the therapeutic usefulness for the treatment of chronic venal insufficiency is proven. Furthermore, regarding the good tolerability of the drug, the use of it can be recommended.

Topics: Animals; Clinical Trials as Topic; Delayed-Action Preparations; Double-Blind Method; Drug Combinations; Escin; Humans; Muscle, Smooth, Vascular; Plant Extracts; Saponins; Venous Insufficiency

This study was performed to test the hypothesis that the heparin and phosphatidylcholine (PDC) included in Aescin gel formulations had the main role of allowing a better penetration of Aescin without important pharmacodynamic effects. Heparin and PDC should be considered as "enhancers". They do not have - at the dosage used - a specific or independent action. An open, registry study of patients - a group with chronic venous insufficiency (CVI) and a group of patients with diabetic microangiopathy were completed.. In patients with CVI and in patients with diabetic microangiopathy, we used a commercial gel preparation containing Aescin, PDC and heparin (group A). The first group of patients used the full complex. The second group used the complex without PDC (group B) and the third (group C) used the complex without heparin.. In both studies the different groups of patients were comparable. In CVI patients (mean age 44.5; SD 2.4; range 40-50) venous microangiopathy was present at the perimalleolar region. Aescin produced comparable microcirculatory results with and without the two other components. Transcutaneus PO2 [TcPO2] increased in all groups. Transcutaneus PCO2 (TcCO2) decreases. The increased Laser Doppler Flux (LDF) (typical of CVI) decreased towards normality. The local Plasma Free Radicals [PFR] levels decreased as the result of better skin perfusion (P<0.05). Comparable data were observed in subjects with diabetic microangiopathy (mean age 46.5; SD 3.1). In these patients the compound was applied at the dorsum of the foot. TcPO2 increased with treatment. TcPCO2, skin flux and PFR decreased towards normal levels (P<0.05).. In conclusion Aescin improves the microcirculation and PFR. Heparin and PDC - included in the gel - have an ancillary role. An improved perfusion and nutrition of the skin was observed both in diabetic and venous microangiopathy. This may possibly contribute in the reduction of the incidence of ulceration associated with diabetic and venous microangiopathy. Aescin-based products may be included in a more complex management plan, including several systemic and local treatments.

Topics: Administration, Topical; Adult; Cardiovascular Agents; Diabetic Angiopathies; Escin; Female; Gels; Heparin; Humans; Male; Microcirculation; Middle Aged; Phosphatidylcholines; Registries; Treatment Outcome; Venous Insufficiency

The aim of this study was to compare the efficacy of Venostasin (horse chestnut seed extract) and Pycnogenol (French maritime pine bark extract) in the treatment of chronic venous insufficiency (CVI). In an open, controlled comparative study 40 patients with diagnosed CVI were treated either with 600 mg chestnut seed extract per day or 360 mg Pycnogenol per day over a period of 4 weeks. The following parameters were investigated before the start of treatment and after 2 and 4 weeks of treatment: circumference of the lower legs and rating of subjective symptoms (scores) of pain, cramps, night-time swelling, feeling of "heaviness", and reddening of the skin. In addition, blood levels of cholesterol LDL and HDL were determined before and at the end of treatment. Pycnogenol significantly reduced the circumference of the lower limbs and significantly improved subjective symptoms. Furthermore, Pycnogenol significantly decreased cholesterol and LDL values in the blood, whereas HDL remained unaffected. Venostasin only moderately but not significantly, reduced the circumference of the lower limbs and marginally improved symptoms. Venostasin had no influence on the determined lipid values. Both medications were equally well tolerated. In conclusion, Pycnogenol was found to be more efficacious than Venostasin for the treatment of CVI.

Topics: Adult; Aged; Cholesterol; Cholesterol, HDL; Cholesterol, LDL; Chronic Disease; Drug Combinations; Escin; Female; Flavonoids; Humans; Leg; Male; Middle Aged; Phytotherapy; Pinus; Plant Bark; Plant Extracts; Platelet Aggregation Inhibitors; Sapindaceae; Seeds; Treatment Outcome; Venous Insufficiency

We report two clinical studies, one already published, performed in patients with early and advanced chronic venous insufficiency (CVI). In both, compression therapy and oral therapy with horse-chestnut seeds extracts (HCSE) were compared to placebo.. The published study in early CVI (Grade I) showed HCSE and compression to be superior to placebo and to be equivalent to each other in reducing lower leg volume, a measure for oedema. In the study, in advanced CVI (Grade II and IIIa), compression appeared to be superior to placebo, whereas HCSE was not. HCSE fared better in Grade II than in Grade IIIa patients. These results are discussed in the light of data from an in vitro model, where HCSE has been able to close the intercellular gaps in the venular endothelium. Not fully specified factors lead to an opening of these gaps, resulting in oedema as well as in local coagulation and thrombosis. The subsequent inflammation keeps these gaps open and initiates and maintains a chronic disease process, which may be the starting point of CVI.. Due to its ability to close the venular endothelial gaps, HCSE seems to be a suitable and protecting therapy during the early stages of CVI. In later more severe stages compression therapy is indicated. Taking into account the observed negative impact of compression on quality of life, pharmacological CVI therapy should start early to avoid progress and to spare patients compression therapy.

Topics: Aesculus; Bandages; Chronic Disease; Double-Blind Method; Drug Combinations; Escin; Humans; Phytotherapy; Plant Extracts; Quality of Life; Venous Insufficiency

The involvement of the microcirculation in chronic venous insufficiency (CVI) due to venous hypertension causes venous hypertensive microangiopathy (VHM) and venous ulceration. VHM is characterized by the presence of enlarged convoluted capillaries; microvascular thrombosis with obliteration of some capillaries; increase in flux, permeability, and edema; and altered function of microlymphatics. PO2 is decreased and CO2 increased. Capillary exchanges are altered, and nutritional alterations eventually lead to venous ulcers. Edema is associated with increased capillary pressure, reduced clearance, and an increased exchange surface of capillaries, which become tortuous and glomerular-like. The aim of this randomized, placebo-controlled study was to evaluate the effect of local treatment with Essaven gel (EG) in 28 subjects with venous microangiopathy due to severe CVI and ulcers treated with a single acute application, Measurements of laser Doppler flux, PO2 and PCO2 in standardized conditions of application showed positive microcirculatory changes (significant decrease of the abnormally increased flux and CO2 while PO2 increased) in the EG treatment group. Changes in the placebo and control group were more limited (changes in the placebo group were mainly associated with skin manipulation when placebo-EG was applied). In conclusion, Essaven gel, in comparison with placebo, acutely improves the microcirculation in VHM even with a single application.

Topics: Administration, Topical; Adult; Aged; Double-Blind Method; Drug Combinations; Escin; Female; Fibrinolytic Agents; Heparin; Humans; Hypertension; Male; Microcirculation; Middle Aged; Peripheral Vascular Diseases; Phospholipids; Varicose Ulcer; Venous Insufficiency

The involvement of the microcirculation in chronic venous insufficiency (CVI), due to venous hypertension, causes venous hypertensive microangiopathy (VHM) and ulceration. VHM is characterized by enlarged, convoluted capillaries; microvascular thrombosis; obliteration of some capillaries; increase in flux, permeability, and edema and altered microlymphatics. PO2 is decreased and CO2 increased. Capillary exchanges are altered and nutritional alterations eventually lead to venous ulcers. Edema is associated with increased capillary pressure, reduced clearance, and increased exchange surface of capillaries, which become tortuous and glomerular-like. The aim of this randomized, placebo-controlled study was to evaluate local treatment with Essaven gel (EG) in subjects with venous microangiopathy and ulcers. Measurements of laser Doppler flux, PO2, and PCO2 in standardized conditions showed positive changes (a significant decrease of the abnormally increased flux and CO2 while PO2 increased) in the EG treatment group. Changes in the placebo and control group were more limited (changes in the placebo group were mainly associated with skin manipulation when placebo-EG was applied). In conclusion, Essaven gel, in comparison with placebo, acutely improves the microcirculation in VHM even with a single acute application.

Topics: Administration, Topical; Double-Blind Method; Drug Combinations; Escin; Fibrinolytic Agents; Heparin; Humans; Middle Aged; Phospholipids; Varicose Ulcer; Venous Insufficiency

In a randomized placebo controlled parallel double blind study on 40 patients suffering from venous edema in chronic deep vein incompetence, the edema-reducing effect of horse chestnut seed extract vs. placebo, being the main test variable, was demonstrated by hydroplethysmography to be statistically significant. In addition, measurements of leg volume under aggravated conditions (edema provocation) were conducted, which yielded the same results. Additional measurements of leg circumference tendentially confirm the demonstrated clinical efficacy of verum, as is true for phlebody-namometric measurements (pressure at rest, minimum pressure, replenishment time) as well. By measuring the leg volume before and after edema provocation, it could be shown that the clinical benefit for the patient is present in all everyday situations (in movement as well as on sitting or standing). Treatment with an edema protective agent of the horse chestnut seed extract type is thus a useful adjunct to compression therapy. The tested preparation were well tolerated.

Topics: Administration, Oral; Adult; Aged; Double-Blind Method; Escin; Exercise Test; Female; Humans; Lymphedema; Male; Middle Aged; Tissue Extracts; Venous Insufficiency

Topics: Adult; Double-Blind Method; Drug Combinations; Escin; Female; Humans; Lymphedema; Plant Extracts; Pregnancy; Pregnancy Complications; Venous Insufficiency

On the basis of numerous pharmacological, clinical pharmacological and clinical investigations it could be proved, that Venostasin ret., standardized on 50 mg triterpenglycosides, calculated as escine, has effects on the venous system: It has tonical effects on the veins, decreases permeability and has protective and curative properties. The mechanism of action is not fully understood, although there are some new interesting biochemical aspects regarding the attenuation of lysosomal proteoglycan destructing enzymes, which are increasingly active in patients with chronic venal insufficiency. In several double-blind randomized cross-over studies it could be demonstrated, that subjective complaints are effectively diminished. As far as objective test variables are concerned (edema), the clinical effectiveness could be shown on the basis of exact biometrical investigations. Thus the therapeutic usefulness for the treatment of chronic venal insufficiency is proven. Furthermore, regarding the good tolerability of the drug, the use of it can be recommended.

Topics: Animals; Clinical Trials as Topic; Delayed-Action Preparations; Double-Blind Method; Drug Combinations; Escin; Humans; Muscle, Smooth, Vascular; Plant Extracts; Saponins; Venous Insufficiency

The effect of horse-chestnut seed extract (standardized on aescin; Venostasin retard) was assessed in a randomized placebo-controlled crossover double-blind trial of 22 patients with proven chronic venous insufficiency by measuring the capillary filtration coefficient and the intravascular volume of the lower leg by venous-occlusion plethysmography. Three hours after taking two capsules of Venostasin (600 mg; each capsule containing 50 mg aescin) the capillary filtration coefficient had decreased by 22%, whereas after administration of an identical-looking placebo capsule it rose but slightly over three hours. The difference in the effect of Venostasin and placebo is statistically significant (P = 0.006). The intravascular volume was reduced 5% more after Venostasin than the placebo, but this is not statistically significant. It is concluded that Venostasin has an inhibitory effect on oedema formation via a decrease in transcapillary filtration and thus improves oedema-related symptoms in venous diseases of the legs.

Topics: Capillary Permeability; Chronic Disease; Clinical Trials as Topic; Double-Blind Method; Drug Combinations; Escin; Female; Humans; Middle Aged; Plant Extracts; Random Allocation; Saponins; Venous Insufficiency

Topics: Administration, Oral; Administration, Topical; Adult; Aged; Clinical Trials as Topic; Drug Combinations; Escin; Female; Flavonoids; Hesperidin; Humans; Male; Middle Aged; Phosphatidylcholines; Saponins; Venous Insufficiency

Topics: Administration, Oral; Administration, Topical; Adult; Aged; Chronic Disease; Clinical Trials as Topic; Drug Combinations; Escin; Female; Flavonoids; Hesperidin; Humans; Male; Middle Aged; Phosphatidylcholines; Random Allocation; Rutin; Saponins; Venous Insufficiency

An open controlled study was performed over a period of 8 weeks to evaluate the effect of Essaven ultra capsules versus placebo in a total of 60 patients suffering from chronic venous insufficiency. Statistical analysis was performed on 29 patients on the active drug (one dropout) and on 25 patients on placebo (5 dropouts). Apart from patients' statements circumference measurements taken of 3 leg segments were used to assess the results of the treatment. In the patients on the active drug there were significant reductions of circumference in the three leg segments (ankle, calf and knee joint) while, in part of the patients on placebo, leg circumference was significantly increased. In the group on active treatment subjective symptoms were also significantly improved in comparison with the controls. The test drug was very well tolerated.

Topics: Anthropometry; Drug Combinations; Drug Evaluation; Escin; Female; Flavonoids; Hesperidin; Humans; Leg; Male; Phosphatidylcholines; Saponins; Venous Insufficiency

Topics: Adolescent; Adult; Aged; Clinical Trials as Topic; Delayed-Action Preparations; Double-Blind Method; Escin; Female; Hemodynamics; Humans; Male; Middle Aged; Placebos; Plant Extracts; Saponins; Varicose Veins; Venous Insufficiency

The aim of this study was to explore the mechanism of domestic beta-aescin treating chronic venous insufficiency through observing its actions on the isolated canine saphenous venous tension, venous pressure, venous return and lymphatic return. The isolated canine spiral saphenous venous tension test was performed to detect the activity of the beta-aescin. Furthermore, in the condition of constant canine femoral artery perfusion kept in the extracorporeal circulation, we measured the changes of the canine femoral artery pressure, femoral artery flow and the lymphatic return flow after intravenous injection of the agent. The results showed that when beta-aescin was administrated at the dose between 5.0 x 10(-5)-5.25 x 10(-4) mol/L, it increased obviously the contractile tension of the venous to norepinephrine in a dose-dependent manner. With canine femoral artery perfusion kept constant, beta-aescin, whose doses were 50 mg and 100 mg, reinforced intently the canine femoral venous tension accelerated the rise of the venous pressure. These finding suggested that domestic betabeta-aescin extracted from Chinese Buckeye Seed had an effect on chronic venous insufficiency by strengthening the venous tension, increasing the venous pressure and promoting venous return and lymphatic return.

Topics: Aesculus; Animals; Dogs; Dose-Response Relationship, Drug; Escin; Femoral Artery; In Vitro Techniques; Indicators and Reagents; Lymphatic System; Muscle Contraction; Muscle, Smooth, Vascular; Norepinephrine; Plant Extracts; Saphenous Vein; Seeds; Vasoconstrictor Agents; Venous Insufficiency; Venous Pressure

Cosmeto-textile applications can be used in the treatment of chronic venous insufficiency in legs by means of elastic bandages loaded with natural products which possess flebotonic properties. We have developed an efficient synthetic procedure for the preparation of β-cyclodextrin (β-CD)-grafted viscose by means of a 2-step ultrasound-assisted reaction. The highly grafted fabric bearing bis-urethane bridged β-CD has been characterized by ATR-FTIR and CP-MAS spectra and by an empiric colorimetric method which used phenolphthalein as the CD guest. We have also developed a suitable cosmetic preparation containing natural substances and extracts (aescin, menthol, Centella asiatica and Ginkgo biloba) to recharge the CD-grafted textile. The efficacy of the new cosmeto-textile has been corroborated by in vitro studies of diffusion through membranes, cutaneous permeation and accumulation in porcine skin. Aescin was taken as a reference compound and its concentration in the different compartments was monitored by HPLC analysis. This cost effective cosmeto-textile shows excellent application compliance and is easily recharged and so has the strong base characteristics needed for possible industrial production.

Topics: Animals; beta-Cyclodextrins; Cellulose; Compression Bandages; Cyclodextrins; Emulsions; Escin; Humans; Molecular Structure; Permeability; Skin; Swine; Venous Insufficiency

Topics: Chronic Disease; Escin; Humans; Plant Extracts; Randomized Controlled Trials as Topic; Reproducibility of Results; Treatment Outcome; Venous Insufficiency

Topics: Bandages; Drug Combinations; Escin; Female; Humans; Male; Plant Extracts; Randomized Controlled Trials as Topic; Research Design; Venous Insufficiency

Within the framework of a case observation study involving more than 800 general practitioners, more than 5,000 patients with chronic venous insufficiency (CVI) were treated with standardised horse chestnut extract and followed up at regular intervals. The evolution of the symptoms, tolerability and adverse drug reactions were recorded. All of the symptoms investigated-pain, tiredness, tension and swelling in the leg, as well as itching and the tendency towards edema-all improved markedly or disappeared completely. The results of this study show that rational treatment with horse chestnut extract represents an economical, practice-relevant therapeutic "pillar", which in comparison with compression has the additional advantage of better compliance.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Combinations; Escin; Female; Humans; Lymphedema; Male; Middle Aged; Plant Extracts; Venous Insufficiency

In 15 patients with primary or secondary chronic venous insufficiency (CHVI) the authors evaluated the action of three weeks' treatment with beta-aescin (Yellon caps). The regression of clinical symptoms of CHVI (sensation of "heavy" and "tired" legs, swollen ankles, nocturnal cramps was complete in five patients, partial or slight in seven patients, and none in three patients (with secondary venous insufficiency associated with thrombosis of the deep venous system). Undesirable effects of the agent were not revealed by common screening tests. No change of the basic parameters of haemostasis occurred. The haemodynamic action on the venous and capillary circulation of the lower extremities was evaluated by the method of venous occlusion plethysmography. Already after the first week of treatment a significant drop of capillary filtration to 74% of the original mean value before treatment occurred (0.265 +/- 0.084 ml/100 ml tissue). After the second and third week of treatment the values of capillary filtration decreased on average to 66% of the original mean value. The venous capacity (before treatment on average 3.5 +/- 0.9 ml/100 ml tissue) and venous drainage (before treatment on average 24.5 +/- 13.5 ml min/100 ml) did not change significantly during treatment.

Topics: Adult; Aged; Chronic Disease; Escin; Female; Hemodynamics; Humans; Leg; Male; Middle Aged; Venous Insufficiency

Topics: Blood Flow Velocity; Escin; Femoral Vein; Humans; Rheology; Saponins; Ultrasonography; Venous Insufficiency

Topics: Drug Combinations; Drug Evaluation; Escin; Flavonoids; Hesperidin; Humans; Leg; Light; Phosphatidylcholines; Plethysmography; Postphlebitic Syndrome; Saponins; Varicose Veins; Venous Insufficiency

Topics: Animals; Capillary Fragility; Capillary Permeability; Drug Combinations; Escin; Flavonoids; Glycosides; Humans; Saponins; Venous Insufficiency

Topics: Drug Combinations; Edema; Escin; Heparin; Humans; Leg; Rutin; Saponins; Thrombophlebitis; Varicose Veins; Venous Insufficiency

Topics: Drug Evaluation; Escin; Female; Humans; Male; Phosphatidylcholines; Rutin; Saponins; Thrombophlebitis; Varicose Veins; Venous Insufficiency