A systematic review of the efficacy and tolerability of hydroxyethylrutosides for improvement of the signs and symptoms of chronic venous insufficiency

Abstract

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.

Placebo in the guise of evidence-based medications

“…The most rigorously conducted trial did not show any additional benefit from Fls in the treatment of venous leg ulcers 98 . Among positive results, subjective improvements (quality of life, pains, cramps, sensation of swelling, heavy legs) are often reported 85,90,99,100 , which may be caused by a placebo effect. Admittedly, an improvement of venous hemodynamics under the influence of MPFF has been reported, confirmed by strain gauge plethysmography and ankle circumference measurements in patients with chronic venous insufficiency 84,[100][101][102][103] .…”

The potential use of flavonoids as venoactive drugs and the role of citrus fruits

“…For example, the most rigorously conducted trial did not show any additional benefit from Fls in the treatment of venous leg ulcers [7]. Among positive results, subjective improvements (quality of life, pains, cramps, sensation of swelling, heavy legs) are often reported [6,13,23,24], which may be caused by a placebo effect. Admittedly, an improvement under the influence of MPFF of venous hemodynamics assessed by strain gauge plethysmography and supramaleolar circumference in patients with CVI has been reported [25][26][27].…”

Management of Venous Stasis Ulcers in the Older Adult

“…Flavonoids, such as escin, hydroxyethylrutoside [31] and Daflon [32], are synthetic and natural plant derivatives. Their anti-inflammatory property and potential to increase venous tone and reduce capillary permeability may attenuate symptoms associated with venous stasis disease (especially, sensation of leg heaviness and pain).…”

“…Medications such as, pentoxifylline, flavonoids, and zinc have been shown to have a positive role in the management of venous disease. Given the potential for prolonged healing in the elderly population, these medications should be considered to enhance wound healing [29][30][31][32][33][34].…”