cardiovascular-agents and Varicose-Veins

Chronic venous disease (CVeD) is a highly prevalent condition in the general population, and it has a significant impact on quality of life. While it is usually manifested by obvious signs, such as varicose veins and venous ulcers, other symptoms of the disease are less specific. Among the other symptoms, which include heaviness, swelling, muscle cramps and restless legs, pain is the symptom that most frequently compels CVeD patients to seek medical aid. However, there is a substantial discrepancy between pain severity and clinically detectable signs of CVeD, questioned by several opposing studies. Further evaluation is needed to clarify this subject, and to analyse whether pain development predicts objective CVeD progression. General management of CVeD starts with advising lifestyle changes, such as lowering body mass index and treating comorbidities. However, the mainstay of treatment is compression therapy, with the additional use of pharmacological substances. Venoactive drugs proved to be the drugs of choice for symptom alleviation and slowing the progression of CVeD, with micronized purified flavonoid fraction being the most effective one. Interventional therapy is reserved for advanced stages of the disease.

Topics: Animals; Cardiovascular Agents; Chronic Disease; Endovascular Procedures; Humans; Pain; Risk Assessment; Risk Factors; Risk Reduction Behavior; Stockings, Compression; Treatment Outcome; Varicose Veins; Venous Insufficiency

Chronic venous disease (CVD) is both prevalent and unavoidable in many people as a result of persistent or unalterable risk factors, the most important of which are advanced age, excess body weight, and family history. Given this inevitability, medical treatment is required to alleviate symptoms and slow disease progression. Venoactive drug therapy is emerging as a valuable treatment option for many CVD patients and micronized purified flavonoid fraction (MPFF) is the most widely prescribed and well-studied venoactive drug available. Recent evidence from animal models of venous hypertension and from clinical trials, as well as from systematic reviews, shows that MPFF is effective at alleviating many of the most common symptoms of CVD including leg pain, leg heaviness, sensations of swelling, cramps, and functional discomfort. In addition, MPFF improves the clinical signs of redness, skin changes, and edema, and improves quality of life. Collectively, these findings support the strong recommendation for MPFF treatment found in the 2018 international guidelines for the management of CVD.Funding: Servier.

Topics: Animals; Cardiovascular Agents; Chronic Disease; Diosmin; Humans; Male; Pain; Risk Factors; Varicose Veins; Venous Insufficiency

The use of a venoactive drug is considered an important component of medical treatment of chronic venous disease (CVD), although the efficacy of certain venoactive drugs (VADs) on one or more individual leg symptoms or signs may have not been extensively studied to justify a strong recommendation in guidelines on CVD. The aim of this systematic review and meta-analysis was to study the effectiveness of the micronized purified flavonoid fraction (MPFF, Daflon®) across the spectrum of defined venous symptoms, signs, quality of life (QoL) and treatment assessment by the physician.. On September 9, 2017, a systematic review of the databases MEDLINE, Scopus and Cochrane Central was performed, supplemented by hand searching, to identify randomized double-blind placebo-controlled trials on MPFF in patients with CVD.. The main outcome measures were the individual and global symptoms, leg edema and redness, skin changes, QoL and evaluation of the overall effectiveness of the treatment by the physician. The effectiveness of MPFF compared with placebo was expressed as risk ratio (RR) or standardized mean difference (SMD) with 95% confidence interval (CI). Trial quality of evidence was graded using the GRADE system.. We identified 7 trials, mostly with low risk of bias, involving 1,692 patients. On qualitative analysis, MPFF significantly improved nine defined leg symptoms, including pain, heaviness, feeling of swelling, cramps, paresthesia, burning sensation, and pruritus (itching), but also functional discomfort compared with placebo, leg redness, skin changes and QoL. On quantitative analysis, MPFF compared with placebo, assessed as a categorical variable, reduced leg pain (RR 0.53, P=0.0001, NNT=4.2), heaviness (RR 0.35, P<0.00001, NNT=2.0), feeling of swelling (RR 0.39, P<0.00001, NNT=3.1), cramps (RR 0.51, P=0.02, NNT=4.8), paresthesia (RR 0.45, P=0.03, NNT=3.5), and functional discomfort (RR 0.41, P=0.0004, NNT=3.0). Similarly, MPFF compared with placebo, assessed as a continuous variable reduced pain (SMD -0.25, 95% CI -0.38 to -0.11), heaviness (SMD -0.80, 95% CI -1.05 to -0.54), feeling of swelling (SMD -0.99, 95% CI -1.25 to -0.73), burning sensation (SMD -0.46, 95% CI -0.78 to -0.14), cramps (SMD -0.46, 95% CI -0.78 to -0.14), and functional discomfort (SMD -0.87, 95% CI -1.13 to -0.61). Regarding objective assessments of leg edema, the use of MPFF compared with placebo reduced ankle circumference (SMD -0.59, 95% CI -1.15 to -0.02), and leg redness (SMD -0.32, 95% CI -0.56 to -0.07, RR 0.50, P=0.03, NNT=3.6), improved skin changes (RR 0.18, P=0.0003, NNT=1.6) and quality of life (SMD -0.21, 95% CI -0.37 to -0.04) and was associated with clinical improvement as assessed by the physician (RR 0.28, P<0.00001, NNT=2.5). Heterogeneity was mostly minimal. The existing evidence where sufficient was mostly of high quality.. Based on high quality evidence, MPFF is highly effective in improving leg symptoms, edema and quality of life in patients with CVD.

Topics: Cardiovascular Agents; Chi-Square Distribution; Chronic Disease; Diosmin; Double-Blind Method; Edema; Humans; Odds Ratio; Quality of Life; Randomized Controlled Trials as Topic; Recovery of Function; Risk Factors; Treatment Outcome; Varicose Veins; Venous Insufficiency

Inflammation represents an important epiphenomenon in the etiopathogenesis of chronic venous disease, a worldwide debilitating condition affecting millions of subjects. The pathophysiology of chronic venous disease (CVD) is based on the hemodynamic abnormalities in conjunction to alterations in cellular and extracellular matrix biocompounds. The endothelial dysfunction results from early perturbation in the endothelium linked to glycocalyx injury and promoted by inflammatory cells and mediators (such as matrix metalloproteinases and interleukins), which lead to progressive dilation of the vein resulting in chronic venous insufficiency. Activated leukocytes during the inflammatory process release enzymes, free radicals, chemokines and inflammatory cytokines in the vessel microenvironment, which are responsible for the changes of the venous wall and venous valve, reflux and venous hypertension, and the development/progression of tissue destruction and skin changes. Sulodexide, a highly purified mixture of glycosaminoglycans composed by 80% fast moving heparin and 20% of dermatan sulphate, exhibits anti-thrombotic and profibrinolytic properties, restoring also the essential endothelial glycocalyx. Glycosaminoglycan sulodexide has been also characterized to reduce the release of inflammatory cytokines/chemokines and to inhibit the matrix metalloproteinases-related proteolytic cascades, counteracting endothelial dysfunctions. The pleiotropic effects of sulodexide set the basis for a very promising agent in treating the spectrum of CVD.

Topics: Animals; Anti-Inflammatory Agents; Cardiovascular Agents; Chronic Disease; Cytokines; Glycosaminoglycans; Humans; Inflammation Mediators; Signal Transduction; Treatment Outcome; Varicose Veins; Veins; Venous Insufficiency

Venous hypoxia has long been postulated as a potential cause of varicosity formation. This article aimed to review the development of this hypothesis, including evidence supporting and controversies surrounding it. Vein wall oxygenation is achieved by oxygen diffusing from luminal blood and vasa vasorum. The whole media of varicosities is oxygenated by vasa vasorum as compared to only the outer two-thirds of media of normal veins. There was no evidence that differences exist between oxygen content of blood from varicose and non-varicose veins, although the former demonstrated larger fluctuations with postural changes. Studies using cell culture and ex vivo explants demonstrated that hypoxia activated leucocytes and endothelium which released mediators regulating vein wall remodelling similar to those observed in varicosities. Venoactive drugs may improve venous oxygenation, and inhibit hypoxia activation of leucocytes and endothelium. The evidence for hypoxia as a causative factor in varicosities remains inconclusive, mainly due to heterogeneity and poor design of published in vivostudies. However, molecular studies have shown that hypoxia was able to cause inflammatory changes and vein wall remodelling similar to those observed in varicosities. Further studies are needed to improve our understanding of the role of hypoxia and help identify potential therapeutic targets.

Topics: Animals; Cardiovascular Agents; Evidence-Based Medicine; Humans; Hypoxia; Oxygen; Risk Assessment; Risk Factors; Treatment Outcome; Varicose Veins; Veins

Topics: Aesculus; Bandages; Cardiovascular Agents; Evidence-Based Medicine; Humans; Phytotherapy; Plant Extracts; Saphenous Vein; Sclerotherapy; Seeds; Treatment Outcome; Varicose Veins

The treatment of varicose veins comprises conservative and active options. Every patient with varices has to be informed on the conservative modalities and should apply them in daily life. Compression therapy, as the most important part of the conservative treatment, should be considered individually for any patient according to the varicose-type, the grade of chronic venous insufficiency and the compliance of the patient. Active treatment modalities are clearly indicated in varices with complications such as trophic skin changes, varicophlebitis or when varices cause pain. But the cosmetic problem should not be underestimated. Morphologic and hemodynamic information obtained by noninvasive duplex technique allows the individualization of the surgical strategy for each patient. Besides surgical techniques used being less and less traumatic (invagination stripping, stab evulsion phlebectomy), more and more interventions are realized under ambulatory conditions in local anesthesia, even crossectomy with partial stripping of truncal varices. More important and complex operations, interventions involving more than one saphenous vein or reinterventions in recurrent varices are still performed under hospital conditions. They require only a short hospitalization time (2 to 4 days). Considering this very favourable evolution in surgery with a net trend to ambulatory, thus more economic treatment, the indications for sclerotherapy--a traditionally ambulatory modality with high recurrence-rate--are limited to reticular varices and telangiectasies.

Topics: Ambulatory Care; Ambulatory Surgical Procedures; Cardiovascular Agents; Humans; Pressure; Sclerotherapy; Varicose Veins; Vascular Surgical Procedures

We evaluated the effects of daflon, a venomimetic agent that regulates the circulatory tonus of the venous system, on pelvic pain and investigated the role of enlarged veins in the pathophysiology of pelvic congestion syndrome.. Twenty women (age 28-35 yrs) with chronic pelvic pain were diagnosed with the syndrome at laparoscopy. They all had prominent broad ligaments and ovarian veins without other pathologies such as endometriosis to explain the etiology of pelvic pain. Ten women were randomized in a fashion to receive 500 mg of Daflon twice/daily for six months, and ten a vitamin pill for placebo effect; they were crossed over for another six months.. At the end of the third month, the frequency and severity of pelvic symptoms began to decrease with daflon compared with the pretreatment and vitamin arm. The mean scores were significantly less at the end of six months, respectively, p < 0.05.. Pharmacologic enhancement of venous tonus may restore pelvic circulation and relieve pelvic symptomatology.

Topics: Adult; Cardiovascular Agents; Diosmin; Female; Humans; Laparoscopy; Pelvic Pain; Pelvis; Treatment Outcome; Ultrasonography; Varicose Veins

The saphenous vein is the most frequently used bypass conduit for vascular reconstructions, which may need to be stored for a prolonged time. The aim of this study was to compare the effect of different preservation solutions on the morphology of saphenous veins during the long-term cold storage.. An in vitro study.. Saphenous vein samples, collected from 29 patients undergoing varicose vein surgery, were stored at +4°C in (1) 10% formalin, (2) isotonic saline with heparin and antibiotic, (3) phosphate-buffered saline, (4) 2.5% glutaraldehyde + phosphate-buffered saline, and (5) Custodiol (histidine-tryptophan-ketoglutarate). Changes in the vein wall were histologically investigated up to day 35. Possible retention of the capacity of endothelial function was evaluated by immunohistochemical detection of endothelial nitric oxide synthase.. Formalin as the control medium well preserved the vein wall morphology, but endothelial nitric oxide synthase immunostaining was very weak. Phosphate-buffered saline and isotonic saline with heparin and antibiotic poorly preserved vein wall morphology. Phosphate-buffered saline endothelial nitric oxide synthase staining decreased dramatically throughout the study period. Compared to phosphate-buffered saline, stronger isotonic saline with heparin and antibiotic endothelial nitric oxide synthase staining was noted at day 35 (p < 0.001). Custodiol and glutaraldehyde better preserved vein morphology compared to ISHA and PBS at day 5 and later (p < 0.001), but compared to stronger isotonic saline with heparin and antibiotic their endothelial nitric oxide synthase staining was weaker.. In terms of preserving the morphology of saphenous veins, phosphate-buffered saline and isotonic saline with heparin and antibiotic were the poorest, while Custodiol and glutaraldehyde were the best. Demonstrating good retention of endothelial nitric oxide synthase staining throughout the study period, isotonic saline with heparin and antibiotic seems to have the best potential to retain vein wall functionality, despite relatively poor morphological preservation.

Topics: Allografts; Cardiovascular Agents; Cold Temperature; Humans; Immunohistochemistry; In Vitro Techniques; Nitric Oxide Synthase Type III; Pharmaceutical Solutions; Random Allocation; Saphenous Vein; Time Factors; Tissue Preservation; Varicose Veins

The authors carried out a study aimed at revealing transitory refluxes along the great saphenous vein (GSV) in patients with intracutaneous varicosity, and at investigating the possibility of removing them by means of preparations of micronized purified flavonoid fraction (MPFF). The study included a total of one hundred and forty-seven 21-to-47-year-old (mean age 31±4.4 years) women presenting with cutaneous varicosity (class C1s). The duration of skin manifestations amounted to 9.4±3.9 years (varying from 4 to 24 years). Telangiectasias were present in 69 (46.9%) women, 36 (24.5%) women had reticular varicosity, and 42 (28.6%) a combination thereof. An author-devised test was used with prolonged orthostatic load consisting in carrying ultrasound duplex scanning twice: in the evening after 6 p. m. and in the morning before 10 a.m., assessing the evening and morning parameters of the GSV, as well as the increment of the diameter of the vein at evening measurement as compared with the morning indices. Women with transitory refluxes along the GSV (n=59) underwent treatment with MPFF preparations (Detralex, Servier) during 60 days at a daily dose of 1,000 mg. The morning examination showed that there was no reflux along the GSV. The evening examination revealed refluxes along the GSV of various pattern and extent in 59 (40.1 %). All the 59 patients with evening refluxes presented complaints for increased fatigability, heaviness in the lower limbs by the end of the day. After 2 months of treatment, of the 59 women with initial reflux, 38 (64.4%) patients had no reflux and in 21 (35.6%) the extent of reflux decreased more than twofold. The evening diameter of the GSV decreased from 5.7 mm (95% CI 4.0-7.1) to 5.2 mm (95% CI 5.5-6.5) and the orthostatic gradient decreased from 0.9 mm (95% CD 0.6-1.3) to 0.6 mm (95% CI 0.4-0.8), p=0.000001. The initial complaints for heaviness in the legs after treatment disappeared in 76.6% of patients (50 of 59 subjects); in 9 women intensity of complaints decreased. The quality of life index decreased from 42 (95% CI 28-55) to 31 (95% CI 15-52) points (p=00001). Conclusions were drawn that in intracutaneous reflux in 40.1% of cases there appear transitory evening refluxes along the GSV revealed in the day-time orthostatic test. Taking MPFFs at a dose of 1,000 mg daily during 2 months removes evening transitory reflexes in 64.4% of cases and in 35.6% of cases decrease them, thus promoting contributing to decreased intensity of. Проведено исследование по выявлению транзиторных рефлюксов по большой подкожной вене (БПВ) у пациентов с внутрикожным варикозом и изучению возможности их устранения с использованием препаратов микронизированной очищенной флавоноидной фракции (МОФФ). В исследование включено 147 женщин в возрасте от 21 до 47 лет (в среднем 31±4,4 года) с кожным варикозом (класс C1s). Длительность существования кожных проявлений составила 9,4±3,9 лет (от 4 до 24 лет). Телеангиоэктазии имелись у 69 (46,9%) пациенток, ретикулярный варикоз – у 36 (24,5%), их сочетание – у 42 (28,6%). Применен авторский тест с длительной ортостатической нагрузкой, заключающийся в проведении ультразвукового дуплексного сканирования дважды: вечером после 18 часов и утром до 10 часов утра. Оценивались вечерний и утренний диаметры БПВ, а также прирост диаметра вены при вечернем измерении в сравнение с утренним. Пациенткам с транзиторными рефлюксами по БПВ (n=59) проведено лечение препаратом МОФФ (Детралекс, Сервье) в течение 60 дней по 1000 мг ежедневно. При утреннем исследовании рефлюкс по БПВ отсутствовал. При вечернем исследовании у 59 (40,1%) человек выявлен рефлюкс по БПВ различного характера и протяженности. Все 59 пациенток с вечерними рефлюксами жаловались на повышенную утомляемость, тяжесть в нижних конечностях к концу дня. Через 2 месяца лечения из 59 женщин с исходным рефлюксом у 38 (64,4%) пациенток он отсутствовал, а у 21 (35,6%) протяженность рефлюкса уменьшилась более чем в 2 раза. Вечерний диаметр БПВ уменьшился с 5,7 мм (95% ДИ 4,0–7,1) до 5,2 мм (95% ДИ 3,5–6,5), а ортостатический градиент – с 0,9 мм (95% ДИ 0,6–1,3) до 0,6 мм (95% ДИ 0,4–0,8), р=0,000001. Исходные жалобы на тяжесть в ногах после лечения исчезли у 74,6% пациентов (50 из 59 человек), у 9 пациенток интенсивность жалоб уменьшилась. Индекс качества жизни снизился с 42 (95% ДИ 28–55) до 31 (95% ДИ 15–52) баллов (р=0,00001). Сделаны выводы, что при внутрикожном варикозе в 40,1% случаев возникают транзиторные вечерние рефлюксы по БПВ, обнаруживаемые при дневном ортостатическом тесте. Прием МОФФ по1 000 мг в сутки в течение 2 месяцев устраняет вечерние транзиторные рефлюксы в 64,4% наблюдений, а в 35,6% наблюдений уменьшает их, способствуя снижению интенсивности венозных жалоб и повышению качества жизни.

Topics: Adult; Cardiovascular Agents; Diosmin; Drug Combinations; Female; Flavonoids; Hesperidin; Humans; Lower Extremity; Quality of Life; Russia; Severity of Illness Index; Telangiectasis; Time Factors; Treatment Outcome; Ultrasonography, Doppler, Duplex; Varicose Veins

Topics: Cardiovascular Agents; Chronic Disease; Glycosaminoglycans; Humans; Treatment Outcome; Varicose Veins; Venous Insufficiency

The Society for Vascular Surgery (SVS) and the American Venous Forum (AVF) have developed clinical practice guidelines for the care of patients with varicose veins of the lower limbs and pelvis. The document also includes recommendations on the management of superficial and perforating vein incompetence in patients with associated, more advanced chronic venous diseases (CVDs), including edema, skin changes, or venous ulcers. Recommendations of the Venous Guideline Committee are based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system as strong (GRADE 1) if the benefits clearly outweigh the risks, burden, and costs. The suggestions are weak (GRADE 2) if the benefits are closely balanced with risks and burden. The level of available evidence to support the evaluation or treatment can be of high (A), medium (B), or low or very low (C) quality. The key recommendations of these guidelines are: We recommend that in patients with varicose veins or more severe CVD, a complete history and detailed physical examination are complemented by duplex ultrasound scanning of the deep and superficial veins (GRADE 1A). We recommend that the CEAP classification is used for patients with CVD (GRADE 1A) and that the revised Venous Clinical Severity Score is used to assess treatment outcome (GRADE 1B). We suggest compression therapy for patients with symptomatic varicose veins (GRADE 2C) but recommend against compression therapy as the primary treatment if the patient is a candidate for saphenous vein ablation (GRADE 1B). We recommend compression therapy as the primary treatment to aid healing of venous ulceration (GRADE 1B). To decrease the recurrence of venous ulcers, we recommend ablation of the incompetent superficial veins in addition to compression therapy (GRADE 1A). For treatment of the incompetent great saphenous vein (GSV), we recommend endovenous thermal ablation (radiofrequency or laser) rather than high ligation and inversion stripping of the saphenous vein to the level of the knee (GRADE 1B). We recommend phlebectomy or sclerotherapy to treat varicose tributaries (GRADE 1B) and suggest foam sclerotherapy as an option for the treatment of the incompetent saphenous vein (GRADE 2C). We recommend against selective treatment of perforating vein incompetence in patients with simple varicose veins (CEAP class C(2); GRADE 1B), but we suggest treatment of pathologic perforating veins (outward flow duration ≥500 ms, vein diameter ≥3.5 m

Topics: Cardiovascular Agents; Compression Bandages; Endovascular Procedures; Evidence-Based Medicine; Humans; Patient Selection; Predictive Value of Tests; Recurrence; Risk Assessment; Sclerotherapy; Severity of Illness Index; Societies, Medical; Treatment Outcome; United States; Varicose Veins; Vascular Surgical Procedures; Venous Insufficiency

Evaluation of the therapeutic effects of calcium dobesilate and diosmin-hesperidin through regulation of apoptosis.. 56 Patients were divided into four groups; Group 1 consisted of patients (n = 18) with the recent diagnosis of primary varicose disorder who have never used medications, Group 2 consisted of patients (n = 14) who have used diosmin-hesperidin for at least six weeks prior to the operation, Group 3 consisted of patients (n = 14) who have used calcium dobesilate for at least six weeks prior to the operation and finally Group 4 (Control group) consisted of normal saphenous vein biopsies (n = 10). All biopsies were stained with Hematoxylin and Eosin. Tissue samples from 56 patients were immunohistochemically stained with antibodies of anti-bcl-2, anti-bax and anti-p53. Apoptosis was evaluated by TUNEL method.. There were no statistically significant differences among the groups in respect to gender distribution and smoking status. Immunohistochemical evaluation of apoptosis related proteins revealed a statistically significant difference between Group 4 and the other groups with respect to the apoptag staining on venous wall (p = 0.026). There were significant differences in the presence of bcl-2 protein expression between groups 4 and Group 1 (p = 0.0002) and between Group 1 and Group 3 (p = 0.023).. Our study highlights the significance of apoptosis in varicose disorders and suggests that calcium dobesilate, which is used in the treatment of varicose veins, could be of benefit by regulating apoptosis.

Topics: Adult; Aged; Apoptosis; bcl-2-Associated X Protein; Calcium Dobesilate; Cardiovascular Agents; Diosmin; Drug Combinations; Female; Hesperidin; Humans; Male; Middle Aged; Preoperative Care; Proto-Oncogene Proteins c-bcl-2; Saphenous Vein; Treatment Outcome; Tumor Suppressor Protein p53; Varicose Veins

Topics: Acute Disease; Anticoagulants; Cardiovascular Agents; Catheter Ablation; Chronic Disease; Fibrinolytic Agents; Humans; Laser Therapy; Pulmonary Embolism; Sclerotherapy; Thrombectomy; Varicose Veins; Vascular Surgical Procedures; Vena Cava Filters; Venous Thrombosis

Topics: Cardiovascular Agents; Catheter Ablation; Chronic Disease; Diagnostic Imaging; Endoscopy; Humans; Leg Ulcer; Ligation; Lower Extremity; Microcirculation; Sclerotherapy; Stockings, Compression; Varicose Veins; Vascular Surgical Procedures; Venous Insufficiency; Venous Thrombosis

The authors tryed by a statistical study to evaluate the efficacy of aphlebotinic therapy in venous diseases induced or aggravated by estroprogestative contraception. During this study, it emerged that the induced functional venous problems were quite virtually corrected by this treatment.

Topics: Adult; Anthocyanins; Ascorbic Acid; Cardiovascular Agents; Contraceptives, Oral, Hormonal; Drug Combinations; Female; Humans; Leg; Lithium; Saponins; Thrombophlebitis; Time Factors; Varicose Veins; Venous Insufficiency

Topics: Cardiovascular Agents; Diosmin; Female; Hemorrhoids; Humans; Intrauterine Devices; Menorrhagia; Menstruation Disturbances; Metrorrhagia; Pregnancy; Pregnancy Complications, Cardiovascular; Uterine Hemorrhage; Varicose Veins; Venous Insufficiency

Topics: Cardiovascular Agents; Drug Therapy; Humans; Varicose Veins; Vascular Diseases

Topics: Cardiovascular Agents; Drug Therapy; Flavonoids; Humans; Private Practice; Varicose Veins

Topics: Cardiovascular Agents; Coumarins; Drug Therapy; Flavonoids; Humans; Lymphedema; Muscle Cramp; Paresthesia; Varicose Ulcer; Varicose Veins

Topics: Cardiovascular Agents; Cardiovascular System; Female; Flavonoids; Humans; Pregnancy; Pregnancy Complications, Cardiovascular; Rutin; Varicose Veins

Topics: Cardiovascular Agents; Ergoloid Mesylates; Ergot Alkaloids; Humans; Ulcer; Varicose Ulcer; Varicose Veins; Veins