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We aimed to assess the efficacy of Centella asiatica for improvement of the signs and symptoms of chronic venous insufficiency (CVI). We searched 13 electronic databases including the Cochrane Central Register of Controlled Trials for randomised controlled trials assessing the efficacy of Centella asiatica for CVI. Two review authors independently selected studies, assessed the risks of bias of included studies and extracted data. The treatment effects of similar studies were pooled whenever appropriate. Eight studies met the inclusion criteria. The pooling of data of similar studies showed that Centella asiatica significantly improved microcirculatory parameters such as transcutaneous partial pressure of CO2 and O2, rate of ankle swelling and venoarteriolar response. Three out of the eight studies did not provide quantitative data. However, these studies reported that patients treated with Centella asiatica showed significant improvement in CVI signs such as leg heaviness, pain and oedema. Our results show that Centella asiatica may be beneficial for improving signs and symptoms of CVI but this conclusion needs to be interpreted with caution as most of the studies were characterised by inadequate reporting and thus had unclear risks of bias, which may threaten the validity of the conclusions.

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SUMMARYWhat is known and objective: Rutoside (rutin; quercetin rutinoside) is a glycoside found in various plant products, including apples, citrus fruits and cranberries. Hydroxyethylrutosides (HR) are semisynthetic derivatives sold as standardized products for the treatment of chronic venous insufficiency (CVI What is new and conclusion: The findings showed that HR produced modest improvements in several symptoms of CVI. However, all the included trials were of limited quality, and therefore, better-quality trials are still required to draw firm conclusions on the usefulness of HR for CVI. WHAT IS KNOWN AND OBJECTIVEThe term chronic venous insufficiency (CVI) describes a condition that affects the venous systems of the lower limbs. It results from the obstruction or reflux of blood flow in the veins due to abnormalities of the venous wall and valves. 1 Because of the abnormalities, venous blood flow is bidirectional, resulting in inefficient venous outflow and high venous pressure.2 Signs and symptoms of CVI may include leg discomfort, heaviness, cramps, pain, oedema and skin changes. The most serious consequence of CVI is venous ulcers. CVI is a common health problem, particularly with ageing. Although CVI is not a fatal condition, it imposes a considerable cost on society in terms of diagnosis, treatments, loss of working hours and impairment of quality of life.