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    Chronic Venous Insufficiency (Holistic)

    Chronic Venous Insufficiency (Holistic)

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    About This Condition

    Say good-bye to CVI-Keep the blood that flows from your feet to your heart in constant motion. According to research or other evidence, the following self-care steps may be helpful.
    • Relieve vein strain

      Wear compression stockings to support veins affected by CVI

    • Fill up on flavonoids

      Strengthen capillaries and veins by taking 1,000 mg of hydroxyethylrutosides or 150 mg of proanthocyanidins daily

    • Discover herbal therapy

      Relieve CVI symptoms by taking standardized extracts of either horse chestnut (100 mg of aescin a day) or butcher's broom (15 mg of ruscogenins a day)


    About This Condition

    Chronic venous insufficiency (CVI) is poor return of blood from feet and legs back to the heart.

    CVI may occur following excessive clotting and inflammation of the leg veins, a disease known as deep vein thrombosis. CVI also results from a simple failure of the valves in leg veins to hold blood against gravity, leading to sluggish movement of blood out of the veins, resulting in swollen legs.


    CVI may cause feet and calves to become swollen, often accompanied by a dull ache made worse with prolonged standing. If CVI is allowed to progress, the skin tends to darken and ulcers may occur. CVI often causes varicose veins .

    Healthy Lifestyle Tips

    People affected by chronic venous insufficiency should not sit or stand for long periods of time. When sitting, they should elevate their legs. Walking helps move blood out of the veins. Wearing tight-fitting compression stockings available from pharmacies further supports the veins.


    What Are Star Ratings?

    Our proprietary "Star-Rating" system was developed to help you easily understand the amount of scientific support behind each supplement in relation to a specific health condition. While there is no way to predict whether a vitamin, mineral, or herb will successfully treat or prevent associated health conditions, our unique ratings tell you how well these supplements are understood by some in the medical community, and whether studies have found them to be effective for other people.

    For over a decade, our team has combed through thousands of research articles published in reputable journals. To help you make educated decisions, and to better understand controversial or confusing supplements, our medical experts have digested the science into these three easy-to-follow ratings. We hope this provides you with a helpful resource to make informed decisions towards your health and well-being.

    3 Stars Reliable and relatively consistent scientific data showing a substantial health benefit.

    2 Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.

    1 Star For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.

    Supplement Why
    3 Stars
    Butcher's Broom
    Standardized extract providing 15 to 30 mg ruscogenins three times per day
    Butcher's broom is a traditional remedy for CVI that has been backed up by clinical trials.

    Another traditional remedy for CVI is butcher's broom . One double-blind trial used a combination of butcher's broom, the flavonoid hesperidin, and vitamin C . This was found to be better than a placebo for treating CVI.1 In a comparison study, a product combining butcher's broom extract, the flavonoid hesperidin, and vitamin C was more effective than a synthetic flavonoid product for treating CVI.2 A double-blind study, in which Butcher's broom alone was used, has confirmed the beneficial effect of this herb.3 Clinical trials have used one capsule, containing standardized extracts providing 15 to 30 mg of ruscogenins, three times each day. The amount of butcher's broom extract used in these trials is 150 mg two times per day. Other sources recommend standardized extracts providing 15 to 30 mg of ruscogenins, given three times each day.

    3 Stars
    500 mg hydroxyethylrutosides twice per day
    Flavonoids strengthen capillaries. A flavonoid derived from rutin, called HR, has been shown to be effective in clearing leg swelling and reducing other CVI symptoms.

    Flavonoids promote venous strength and integrity. Most trials of flavonoids in patients with CVI have used a type of flavonoid called hydroxyethylrutosides (HR), which is derived from rutin. These double-blind and other controlled trials have consistently shown a beneficial effect of HR in clearing leg swelling and other signs of CVI.4 , 5 , 6 Positive results from a double-blind trial have been obtained using 500 mg of HR taken twice per day for 12 weeks.7 In this trial, the preparation was found to add further benefit to that provided by compression stockings commonly used to treat CVI. Similar results were obtained in another controlled trial.8 It is unclear whether other flavonoids are as effective as HR for CVI. HR has also been used successfully as a topical preparation for the treatment of CVI.9

    3 Stars
    Horse Chestnut
    Standardized extract providing 50 mg aescin two to three times per day
    Horse chestnut is traditionally used for venous problems, and its effectiveness has been backed up by an extensive overview of clinical trials.

    According to an extensive overview of clinical trials, standardized horse chestnut seed extract, which contains the active compound aescin, has been shown to be effective in double-blind and other controlled research, supporting the traditional use of horse chestnut for venous problems.10 In these trials, capsules of horse chestnut extract containing 50 mg of aescin were given two to three times daily for CVI. The positive effect results in part from horse chestnut's ability to strengthen capillaries, which leads to a reduction in swelling.11

    3 Stars
    50 to 100 mg two to three times daily
    Proanthocyanidins, a group of flavonoids, have been shown to strengthen capillaries in double-blind research.

    Proanthocyanidins (OPCs), a group of flavonoids found in pine bark, grape seed, grape skin, bilberry , cranberry , black currant, green tea , black tea, and other plants, have also been shown to strengthen capillaries in double-blind research using as little as two 50 mg tablets per day.12 In a double-blind trial using a total of 150 mg OPCs per day, French researchers reported reduced symptoms for women with CVI.13 In another French double-blind trial, supplementation with 100 mg taken three times per day resulted in benefits within four weeks.14

    3 Stars
    150 to 300 mg per day
    A controlled study reported that supplementing daily with Pycnogenol improved symptoms of chronic venous insufficiency and reduced associated leg swelling.
    A controlled study reported that 150 mg per day of Pycnogenol improved symptoms of chronic venous insufficiency (CVI) and reduced associated leg swelling.15 Double-blind trials have also found that 100 mg of Pycnogenol two to three times daily reduced symptoms of CVI and improved measurements of blood flow and pressure inside of the veins.16 , 17 A controlled trial found that 150 mg per day of Pycnogenol was more effective for CVI than use of elastic stockings alone, but that a combination of the two was better than either treatment alone.18 Several preliminary studies of CVI have investigated pycnogenol in comparison to or combined with other flavonoid extracts. These studies reported that Pycnogenol (150 to 300 mg per day) was more effective than 1,000 mg per day of a flavonoid mixture of 90% diosmin and 10% hesperidin,19 that 360 mg per day of Pycnogenol was more effective than 600 mg per day of horse chestnut seed extract,20 and that a daily combination of 40 mg Pycnogenol and 940 mg hydroxyethylrutosides was more effective than 1,200 mg per day of hydroxyethylrutosides alone.21
    2 Stars
    Gotu Kola
    60 to 120 mg daily of a standardized herbal extract
    Gotu kola extracts have been found to be successful in treating CVI in preliminary trials.

    Gotu kola extracts, standardized to triterpenoid content, have been found successful in small preliminary trials to treat CVI.22 The amount of extract used in these trials ranged from 60 to 120 mg per day.

    2 Stars
    Red Vine Leaf
    360 to 720 mg daily of a standardized herbal extract
    In one study, people who took red vine leaf experienced reduced leg heaviness, tension sensation, tingling, pain, and leg swelling.

    A double-blind trial demonstrated that red vine leaf extract is effective at relieving the symptoms and swelling associated with CVI.23 One group of participants took either 360 mg or 720 mg per day of a standardized extract for 12 weeks, and another group took a placebo. At the end of the treatment period, those who had taken the herb experienced significant improvement in symptoms of leg heaviness, tension sensation, tingling, and pain compared with those who had taken the placebo. Objective measurements of leg swelling were also significantly improved in the red vine group compared to the placebo group.


    1. Cappelli R, Nicora M, Di Perri T. Use of extract of Ruscus aculeatus in venous disease in the lower limbs. Drugs Exp Clin Res 1988;14:277-83.

    2. Beltramino R, Penenory A, Buceta AM. An open-label, randomized multicenter study comparing the efficacy and safety of Cyclo 3 Fort® versus hydroxyethyl rutoside in chronic venous lymphatic insufficiency. Angiology 2000;51:535-44.

    3. Vanscheidt W, Jost V, Wolna P, et al. Efficacy and safety of a Butcher's broom preparation (Ruscus aculeatus L. extract) compared to placebo in patients suffering from chronic venous insufficiency. Arzneimittelforschung2002;52:243-50.

    4. Rehn D, Brunnauer H, Diebschlag W, Lehmacher W. Investigation of the therapeutic equivalence of different galenical preparations of O-(s-hydroxyethyl)-rutosides following multiple dose per oral administration. Arzneimittelforschung 1996;46:488-92.

    5. Bergqvist D, Hallbook T, Lindblad B, Lindhagen A. A double-blind trial of O-(s-hydroxyethyl)-rutoside in patients with chronic venous insufficiency. Vasa 1981;10:253-60.

    6. Poynard T, Valterio C. Meta-analysis of hydroxyethylrutosides in the treatment of chronic venous insufficiency. Vasa 1994;23:244-50.

    7. Unkauf M, Rehn D, Klinger J, et al. Investigation of the efficacy of oxerutins compared to placebo in patients with chronic venous insufficiency treated with compression stockings. Arzneimittelforschung 1996;46:478-82.

    8. Neumann HA, van den Broek MJ. A comparative clinical trial of graduated compression stockings and O-(beta-hydroxyethyl)-rutosides (HR) in the treatment of patients with chronic venous insufficiency. Z Lymphol 1995;19:8-11.

    9. Frick RW. Three treatments for chronic venous insufficiency: escin, hydroxyethylrutoside, and Daflon. Angiology 2000;51:197-205 [review].

    10. Pittler MH, Ernst E. Horse-chestnut seed extract for chronic venous insufficiency: a criteria-based systematic review. Arch Dermatol 1998;134:1356-60.

    11. Bisler H, Pfeifer R, Klüken N, Pauschinger P. Effects of horse-chestnut seed extract on transcapillary filtration in chronic venous insufficiency. Deutche Med Wochenschr 1986;111:1321-9 [in German].

    12. Dartenuc JY, Marache P, Choussat H. Resistance Capillaire en Geriatrie Etude d'un Microangioprotecteur. Bordeax Médical 1980;13:903-7 [in French].

    13. Delacroix P. Etude en Double Avengle de l'Endotelon dans l'Insuffisance Veineuse Chronique. Therapeutique, la Revue de Medicine 1981;Sept 27-28:1793-1802 [in French].

    14. Thebaut JF, Thebaut P, Vin F. Study of Endotelon in functional manifestations of peripheral venous insufficiency. Gazette Medicale 1985;92:96-100 [in French].

    15. Cesarone MR, Belcaro G, Rohdewald P, et al. Rapid relief of signs/symptoms in chronic venous microangiopathy with pycnogenol: a prospective, controlled study. Angiology 2006;57:569-76.

    16. Petrassi C, Mastromarino A, Spartera C. PYCNOGENOL in chronic venous insufficiency. Phytomedicine 2000;7:383-8.

    17. Arcangeli P. Pycnogenol in chronic venous insufficiency. Fitoterapia 2000;71:236-44.

    18. Cesarone MR, Belcaro G, Rohdewald P, et al. Improvement of signs and symptoms of chronic venous insufficiency and microangiopathy with Pycnogenol(R): A prospective, controlled study. Phytomedicine 2010 Jun 23. [E-pub ahead of print]

    19. Cesarone MR, Belcaro G, Rohdewald P, et al. Comparison of Pycnogenol and Daflon in treating chronic venous insufficiency: a prospective, controlled study. Clin Appl Thromb Hemost 2006;12:205-12.

    20. Koch R. Comparative study of Venostasin and Pycnogenol in chronic venous insufficiency. Phytother Res 2002;16:S1-5.

    21. Riccioni C, Sarcinella R, Izzo A, et al. Effectiveness of Troxerutin in association with Pycnogenol in the pharmacological treatment of venous insufficiency. Minerva Cardioangiol 2004;52:43-8 [in Italian].

    22. Brinkhaus B, Linder M, Schuppan D, Hahn EG. Chemical, pharmacological and clinical profile of the East Asian medical plant Centella asiatica. Phytomedicine 2000;7:427-48.

    23. Kiesewetter H, Koscielny J, Kalus U, et al. Efficacy of orally administered extract of red vine leaf AS 195 (folia vitis viniferae) in chronic venous insufficiency (stages I-II). A randomized, double-blind, placebo-controlled trial. Arzneimittelforschung 2000;50:109-17.

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