Conservative treatment of chronic venous disease: the Italian experience

Chronic venous disease (CVD) is a highly prevalent clinical condition with substantial epidemiological implications and socioeconomic repercussions. CVD is a worldwide problem and does not only affect patients in Western countries. The consequences of its high prevalence, diagnosis and therapy costs, significant worker absenteeism, and its impact on patients'quality of life are well known. Pharmacotherapy for CVD, solely represented by venoactive drugs, has seen great developments over the last 40 years. Venoactive drugs are widely used in the symptomatic treatment of CVD together with compression therapy in order to relieve patient suffering. The clinical efficacy of venoactive drugs on symptoms (sensations of heaviness, leg pain, paresthesia, sensations of warmth and burning, swelling, night cramps, etc) has long been confirmed by both open and end-controlled studies. We carried out a joint analysis of the management and costs of CVD in Italy and found that pharmacotherapy is very useful in both. Doubleblind randomized trials have used micronized purified flavonoid fraction, rutosides, escin, anthocyanosides, and synthetic calcium dobesilate in the treatment of CVD. In the following state-of-the-art review article, we have used evidence-based medicine methods to review publications found in the medical literature. Particular consideration was given to the evidence obtained in meta-analyses, guidelines, and consensus statements. Currently, the evidence for pharmacological agents such as venoactive drugs in the treatment of CVD suggests their wide use for the resorption of venous edema and the relief of venous symptoms associated with all classes of the CEAP classification.