Chronic

Understanding Chronic Venous Disease1,2

In Chronic Venous Disease, leg veins do not working properly mainly due to weak valves and it is difficult for blood to pass through veins and walls or valves to go back to the heart. Most studies have shown that Chronic Venous Disease is more prevalent among women, although in a recent study, the differences between sexes was small. Advance stage of Chronic Venous Disease is known as Chronic Venous Insufficiency (CVI).


Chronic Venous Disease(CVD)

Chronic Venous Disease(CVD) affects millions of individuals worldwide, 5% of Indian population, but little is known of how it is managed in routine clinical practice. 3,4


CEAP Classification of Chronic Venous Disease5

In 1993, the CEAP classification (Clinical-Etiological-Anatomical-Pathophysiological) was created to standardize the diverse manifestations of Chronic Venous Disease. The most recent one was revised in 2020.



Here is how to diagnose Chronic Venous Disease in its early stages6

Symptoms of Chronic Venous Disease range from mild to advanced stages.7

Chronic Venous Disease can also have serious clinical manifestations like Phlebo-Arthrosis 7



Medical therapy forms the basis of early management of Chronic Venous Disease 8



For advanced Chronic Venous Disease we rely on surgical interventions 9



Understanding role of Micronized Purified Flavonoid Fraction(MPFF) in medical management

RELIEF study showed that the use of MPFF improves Quality of Life among Chronic Venous Disease patients.10


Micronized Purified Flavonoid Fraction(MPFF)

MPFF is a gold standard treatment for all stages of Chronic Venous Disease of CEAP classification. It is an adjunct to surgical procedures in the treatment of Chronic Venous Disease.11


MPFF during Sclerotherapy of Reticular Veins and Telangiectasias11


  • Resolution of Venous symptoms post-sclerotherapy was greater in patients treated with MPFF compared with those undergoing sclerotherapy alone.
  • MPFF treatment was associated with statistically significant decreases in mean visual analog scale (VAS) scores for leg heaviness, pain.

Reduces severity and accelerated recovery12

MPFF reduces severity and accelerated recovery to patients undergoing endovenous treatment (EVT) for Varicose Veins of the lower extremities.

Accelerated healing of Venous
Ulcers13,14


MPFF treatment accelerated Venous Ulcer healing. The chance of healing ulcer was 32% better in patients treated with adjunctive MPFF than in those managed by conventional therapy alone.



Recommended Dose of MPFF

The usual dose of MPFF is 1000mg 15


References

1. Robert T Eberhardt, Joseph D Raffetto. Chronic Venous Insufficiency. 2014.AHA Journals. 2. Joan M Lohr, Ruth L Bush. Venous disease in women: Epidemiology, manifestations, and treatment.2013. Journal of Vascular Surgery. 3. Joseph D. Raffetto. Pathophysiology of Chronic Venous Disease and Venous Ulcers. 2017. Surg Clin N Am 4. Siddharth Mishra, Iqbal Ali, Gurjit Singh. A study of epidemiological factors and clinical profile of primary varicose veins. 2016. Medical Journal of Dr. DY Patil Vidyapeeth. 5. Lurie, F., Passman, M., Meisner, M., Dalsing, M., et al. (2020). The 2020 update of the CEAP classification system and reporting standards. Journal of vascular surgery. Venous and lymphatic disorders, 8(3), 342–352. https://doi.org/10.1016/j.jvsv.2019.12.075 6. Krishnan, Shyam, and Stephen C Nicholls. “Chronic Venous insufficiency: clinical assessment and patient selection.” 2005. Seminars in interventional radiology. 7. Armando Mansilha, Joel Sousa. Pathophysiological Mechanisms of Chronic Venous Disease and Implications for Venoactive Drug Therapy.2018. 8. Mansilha, Armando. “Early Stages of Chronic Venous Disease: Medical Treatment Alone or in Addition to EndoVenous Treatments.” 2020 Advances in therapy. 9. Marianne G. De Maeseneer, Stavros K. Kakkos , Thomas Aherne , Niels Baekgaard, Stephen Black, Lena Blomgren. et.al. European Society for Vascular Surgery (ESVS) 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs 10. Pinjala R et al. Phlebology 2004;19:179-184 11. Bogachev et al. Adv Ther. 2018;35:1001-1008 12. Bogachev et al, DECISION Trial Phlebolymphology 2013;20(4):181-187. 13. Nicolaides et al. Int Angiol. 2018; 37:181-254 14. Coleridge-Smith P. et al. Eur J Vasc Endovasc Surg. 2005;30:198-208 15. Staniewska A. Bezpieczeństwo stosowania zmikronizowanej diosminy w dawkach dobowych do 2000 mg [Safety of use of micronized diosmin at daily doses up to 2000 mg per day]. Pol Merkur Lekarski. 2016