Avazashvili D.N., Kacadze T.Sh., Buachidze T.O., Avazashvili N.N.
Department of Angiosurgery and Emergency microsurgery
Tbilisi №1 Clinical Hospital
Chronic Venous Insufficiency (CVI) is one of the leading causes of morbidity in developed countries. Therefore treatment strategy of CVI has the great significance. It is especially important to develop new effective strategies in conservative treatment, as abilities and results of surgical treatment are quite limited and contradictory.
The main goal of this study report is to evaluate effect of Venodiol in patients with CVI.
Stuff and methods:
The study was conducted on the base of Department of angiosurgery and emergency microsurgery of Tbilisi №1 clinical hospital. Study period: February – October of 2007 year.
72 patients were evaluated for ambulatory and stationary treatment. Patients age was in the range of 49-70 years and 49 (68,1%) of them were women and 23 (31,9%) were men. The majority of patients (53 of them - 73,6%) had developed CVI on the basis of deep vein thrombosis (the etiologies of thrombosis were different – angiologic complications of endoprothesis and osteosynthesis of hip and thigh among them). CVI developed due to untreated varicouse veins in the rest (19 -26,4%) of the patients. Skin trophic changes was described in 35 (48,6%) patients. Indurating pigment dermatitis was developed in 24 (33,3%) and trophic ulcer in 11 (15,3 %) of cases.
All evaluated patients were treated conservatively with the following groups of medications:
· Antiinflamatory preparation – Loxidol (Meloxicam) 15 mg/day
· Antihistamin preparation – Phexophenadin 180 mg/day
· combined venotonics – Venodiol 1 tablet twice daily.
Anticoagulant (low-molecular-weight heparin 0,4ml once or twice daily) or desagregants (aspirin 100 mg once daily) were used as indicated. In addition antibiotics were given to patients with trophic ulcer along with topical treatment and ultraviolet been therapy according to approved methods in our department. This complex treatment was conducted for about 10-14 days and then venodiol as monotherapy or in combination with desagregants was given for 4-6 weeks.
Results and review:
Results of conducted study were assessed in 61 patients. 11 patients were lost from a field of vision (for unnown reasons). Efficiency of Venodiol was evaluated in 6 weeks of treatment initiation, when the patients used it as monotherapy or in combination with desagregants. All patients described subjective improvement of condition. The fatigue, heaviness feeling and muscle cramps decreased in legs. Objectively swelling intensity lessened and leg dimension decreased with 15-20 mm. Coagulation measurements normalized, (though this effect probably was due to anticoagulants and/or desagregants). All patients mentioned raise in physical activity tolerance - walking distance increase without leg swelling and heaviness.
Trophic ulcers did not heal in any patients, but positive dynamics of reparation processes (decrease of ulcer discharge, granulation development, decrease of the area of ulcer) were evident in all cases, this was the representation of venous flow normalization, due to venotonic preparations.
Such efficiency of Venodiol, in the treatment of CVI in our point of view is due to its optimal pharmacologic composition. On the one hand, Venodiol contains Flavonoids – diosmine, hesperidine and, on the other hand, ascorbic acid (Vitamin C).
CVI of lower extremities is the multifactorial disease, which is caused by progressing deterioration of venous valves and vein walls functioning and also post thrombotic venous trunks obturation. Flavonoids (diosmine, hesperidine) effectively affect vein wall tonus with the elevation of wall noradrenalin activity. Diosmine and hesperidine improve microcirculation and decrease juxtacapillary shunt in tissues thus increase oxygen tension. Some authors describe diosmine’s and hesperidine’s effect to decrease damaging action of neutrophils and their factors on venous walls. Ascorbic acid which is the powerful antioxidant and immunomodulator also decrease venous wall injury, and raise general resistance of an organism. All described lead to treatment efficiency of this medication.
Also, it should be mentioned that high micronized flavonoids raise bioavailability of the preparation and correspondingly its therapeutic effect.
Therefore, based on the described trial, Venodiol can be considered as drug of choice in the treatment of CVI and can be recommended for wide usage in medical practice.
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