Aims: To investigate the effectiveness and tolerability of adjunctive micronized purified flavonoid fraction (MPFF) in patients with chronic venous disease (CVD). Patients & methods: This observational study included adults (≥18 years) with clinical–etiology–anatomy–pathophysiology (CEAP) class C4 CVD for whom MPFF was indicated. Outcomes included changes in subcutaneous adipose thickness, venous clinical severity score, CVD symptoms (using a visual analogue scale) and tolerability. Results: Of 381 patients, 365 completed the study. After 6 months, subcutaneous adipose tissue thickness, venous clinical severity score and visual analogue scale scores significantly improved (all p < 0.001 vs baseline). No adverse drug reactions occurred. Conclusion: Adjunctive MPFF treatment improves skin and subcutaneous tissue conditions in CVD patients. Clinical Trial Registration: NCT04138576 ( ClinicalTrials.gov )
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