Chronic Venous Insufficiency

Chronic venous insufficiency is a condition in which the veins of the legs are unable to pump blood up toward the heart. Symptoms include leg swelling, itchy skin, ulcers, and varicose veins.

Quick Answer

What it is

Chronic venous insufficiency is a condition in which the veins of the legs are unable to pump blood up toward the heart. Symptoms include leg swelling, itchy skin, ulcers, and varicose veins.

Key findings

Grade A: Chronic Venous Insufficiency Signs (Gotu Kola)
Grade A: Leg Edema Reduction (Diosmin)
Grade A: Chronic Venous Insufficiency Symptoms (Diosmin)

Safety

Cochrane meta-analysis: Phlebotonics probably increase adverse events slightly vs placebo (RR 1.14, 95% CI 1.02-1.27).

ℹ️ Quick Facts

Quick Facts: Chronic Venous Insufficiency

Supplements Studied:7
Research Trials:12
Total Participants:1,612
Grade A Supplements:3
Top Supplement:Gotu Kola (A)

12 trials

1,612 participantsppts

7 supps · 24 outcomes

Evidence-Based Protocol

Supplement stack ranked by research quality

Strong Evidence

Primary Stack (Tier 1)

Horse Chestnut Seed ExtractA

300mg twice daily (standardized to 50mg aescin per dose)

Aescin reduces capillary permeability, improves venous tone, and decreases leg swelling and pain

20 studies | 2,000 participants

Gotu Kola (Centella asiatica)A

60-180mg triterpenes daily (standardized extract)

Triterpenes strengthen connective tissue, improve microcirculation, and reduce venous hypertension

15 studies | 1,000 participants

Supporting Stack (Tier 2)

Pycnogenol (Pine Bark Extract)B

100-150mg daily

Strengthens capillary walls, reduces edema, and improves microcirculation

10 studies | 500 participants

Butcher's Broom (Ruscus aculeatus)B

150mg twice daily (standardized to ruscogenins)

Ruscogenins have venotonic effects, reducing venous stasis and improving symptoms

8 studies | 400 participants

Diosmin-Hesperidin (Micronized)A

500mg twice daily or 1000mg once daily (micronized form)

Bioflavonoids that reduce capillary permeability, improve venous tone, and reduce inflammation

25 studies | 2,500 participants

Grape Seed ExtractB

100-300mg daily

Proanthocyanidins strengthen vascular walls and reduce edema

8 studies | 400 participants

How It Works

Chronic venous insufficiency (CVI) occurs when the veins in the legs don't efficiently return blood to the heart, usually due to damaged valves. Blood pools in the legs, causing symptoms like heaviness, aching, swelling, skin changes, and in severe cases, venous ulcers. CVI affects up to 40% of women and 17% of men. While compression stockings and leg elevation are foundational treatments, several well-studied plant extracts can significantly improve symptoms.

IMPORTANT: CVI should be evaluated by a healthcare provider to assess severity and rule out deep vein thrombosis. Compression therapy remains the cornerstone of treatment. These supplements can provide additional benefit.

•Horse Chestnut Seed Extract is one of the most studied natural treatments for CVI. Its active compound, aescin, reduces the permeability of tiny blood vessels (so less fluid leaks into tissues), improves venous tone, and has anti-inflammatory effects. A Cochrane review found it as effective as compression stockings for reducing leg swelling and pain.

•Gotu Kola (Centella asiatica) contains triterpenes that strengthen the connective tissue in blood vessel walls. It improves microcirculation and reduces venous pressure. Studies show it significantly reduces symptoms like heaviness, pain, and swelling, and may help prevent progression to more severe disease.

•Pycnogenol (French maritime pine bark extract) contains powerful antioxidants that strengthen capillary walls and reduce inflammation. Studies show it improves symptoms of CVI including swelling, heaviness, and discomfort. It may also help prevent the leg skin changes associated with chronic venous disease.

•Butcher's Broom contains ruscogenins that have direct venotonic effects—they cause veins to constrict, improving blood return to the heart and reducing venous pooling. European guidelines include it as a treatment option for CVI.

•Diosmin-Hesperidin (often sold as MPFF or Daflon) is widely used in Europe for venous disorders. These citrus-derived bioflavonoids improve venous tone, reduce capillary permeability, and have anti-inflammatory effects. The micronized form is better absorbed. Multiple studies show it reduces symptoms and improves quality of life.

•Grape Seed Extract contains proanthocyanidins that strengthen blood vessel walls and reduce fluid leakage into tissues. It may help reduce leg swelling and discomfort.

Expected timeline: Horse chestnut: 2-4 weeks for symptom improvement. Gotu kola: 4-8 weeks. Pycnogenol: 4-8 weeks. Diosmin: 2-4 weeks. These work best combined with compression therapy and lifestyle measures (leg elevation, exercise, avoiding prolonged standing).

Generated from peer-reviewed researchSchema v2.0

Supplements for Chronic Venous Insufficiency

Sorted by strength of evidence

AGotu Kola

2 outcomes · 18 studies

↑Chronic Venous Insufficiency SignsImproves↑Blood FlowImproves↑Leg EdemaWorsens

ADiosmin

1 outcome

↑Leg Edema ReductionImproves↑Chronic Venous Insufficiency SymptomsWorsens↑Quality of Life in CVDImproves

AHorse Chestnut

1 outcome · 14 studies

↑Chronic Venous Insufficiency SignsImprovesHigh-density lipoprotein (HDL)↓PainImproves

BPycnogenol

1 outcome · 10 studies

↑Chronic Venous Insufficiency SignsImproves↑Leg EdemaWorsens↑High-density lipoprotein (HDL)Improves

CButcher's Broom

1 outcome · 3 studies

↑Chronic Venous Insufficiency SignsImproves↓Leg EdemaImproves↑Subjective Well-BeingImproves

CRutin

1 outcome · 14 studies

↓Leg SymptomsImproves↓EdemaImproves

Detailed Outcomes

Grade:

Effect:

Size:

Sort:

Chronic Venous Insufficiency Signs

Moderate Improvement

6 studies363 participants

moderate↑Improves

Blood Flow

Small Increase

1 study60 participants

small↑Improves

Leg Edema

8 studies544 participants

↑Worsens

Microcirculation

3 studies174 participants

↑Improves

Chronic Venous Insufficiency Signs

Moderate Improvement

3 studies297 participants

moderate↑Improves

High-density lipoprotein (HDL)

No effect

1 study40 participants

none

Pain

6 studies543 participants

↓Improves

Leg Edema

3 studies297 participants

↑Worsens

Low-density lipoprotein (LDL)

1 study40 participants

↓Improves

Leg Edema Reduction

Cochrane meta-analysis (56 RCTs, n=7690, 2020): Phlebotonics including diosmin/MPFF reduced lower leg edema (RR 0.70, 95% CI 0.63-0.78) and ankle circumference (MD -4.27mm, 95% CI -5.61 to -2.93) vs placebo. Moderate-certainty evidence.

moderate↑Improves

Chronic Venous Insufficiency Symptoms

Systematic review and meta-analysis: MPFF (Daflon) highly effective in improving leg symptoms including pain, heaviness, fatigue, paresthesia. MPFF is the only venoactive drug with Grade 1B recommendation in international CVD guidelines.

moderate↑Worsens

Quality of Life in CVD

RCT for low-dose diosmin: Improved symptoms and quality of life in CVD patients. However, Cochrane meta-analysis found phlebotonics probably make little or no difference in QoL compared with placebo (moderate-certainty evidence).

small↑Improves

Safety Profile

Cochrane meta-analysis: Phlebotonics probably increase adverse events slightly vs placebo (RR 1.14, 95% CI 1.02-1.27). GI disorders most common. Generally well-tolerated for short-term use. Long-term safety data limited.

moderate↑Improves

Chronic Venous Insufficiency Signs

Moderate Improvement

2 studies126 participants

moderate↑Improves

Leg Edema

5 studies423 participants

↑Worsens

High-density lipoprotein (HDL)

1 study40 participants

↑Improves

Low-density lipoprotein (LDL)

1 study40 participants

↑Worsens

Total cholesterol

1 study40 participants

↑Worsens

Leg Symptoms

Small-moderate improvements in leg heaviness, cramps, swelling (systematic review)

8 studies600 participants

small↓Improves

Edema

Modest reduction in ankle swelling

6 studies450 participants

small↓Improves

Chronic Venous Insufficiency Signs

Small Improvement

1 study110 participants

small↑Improves

Leg Edema

Improvement

1 study110 participants

↓Improves

Subjective Well-Being

1 study110 participants

↑Improves

Wound Healing

1 study57 participants

↑Improves

Research Citations (60)

Is There a Difference in the Clinical Efficacy of Diosmin and Micronized Purified Flavonoid Fraction for the Treatment of Chronic Venous Disorders? Review of Available Evidence

Int J Angiol (2021)

PMID: 34559247

Phlebotonics for venous insufficiency

Cochrane Database Syst Rev (2020)

PMID: 33141449

Micronized Purified Flavonoid Fraction in Hemorrhoid Disease: A Systematic Review and Meta-Analysis

Clin Drug Investig (2020)

PMID: 32766451

Efficacy of micronized purified flavonoid fraction (Daflon) on improving individual symptoms, signs and quality of life in patients with chronic venous disease: a systematic review and meta-analysis of randomized double-blind placebo-controlled trials

Phlebology (2018)

PMID: 29385792

Recommendations for the medical management of chronic venous disease: The role of Micronized Purified Flavanoid Fraction (MPFF)

Phlebolymphology (2017)

PMID: 28211296

Therapeutic potential of micronized purified flavonoid fraction (MPFF) of diosmin and hesperidin in treatment chronic venous disorder

Phlebology (2016)

PMID: 26465280

Flavonoids for treating venous leg ulcers

Cochrane Database Syst Rev (2013)

PMID: 23728661

Micronised purified flavonoid fraction: a review of its use in chronic venous insufficiency, venous ulcers and haemorrhoids

Drugs (2003)

PMID: 12487623

From symptoms to leg edema: efficacy of Daflon 500 mg

Angiology (2003)

PMID: 12934755

Clinical benefits of Daflon 500 mg in the most severe stages of chronic venous insufficiency

Angiology (2001)

PMID: 11510597

Related Conditions

Skin Health

4 shared supplements · 110 outcomes

Skin health refers to the integrity of skin function. Healthy skin maintains a barrier between the external environment and the inside of the body, and is characterized as smooth, moisturized, clear of blemishes, and radiant.

Varicose Veins

2 shared supplements · 3 outcomes

Varicose veins are large, dilated, twisting veins that commonly appear in the lower extremities and can cause pain, aching, tingling, and discomfort. Symptoms may be improved with compression therapy, exercise, and supplements that reduce inflammation and improve blood flow in the legs.

Type 2 Diabetes

2 shared supplements · 868 outcomes

Type 2 diabetes (T2D) is a disease in which blood glucose levels are too high. It is characterized by insulin resistance in muscle, fat, and pancreas cells and an inability of the pancreas to manufacture enough insulin to control blood glucose levels. T2D is strongly associated with excess body fat, and weight loss induced by lifestyle changes is extremely effective for treating T2D.

High Blood Pressure

2 shared supplements · 393 outcomes

High blood pressure is when the force of your blood pushing against the walls of the arteries is consistently too high. High blood pressure is often caused by an unhealthy lifestyle, although it can result from other medical conditions as well.

Hemorrhoids

2 shared supplements · 3 outcomes

Hemorrhoids are a common medical condition in which blood vessels in the anus become swollen and displaced. Hemorrhoids are not particularly harmful, but they can cause significant discomfort, including bleeding, itching, and pain.

2 shared supplements · outcomes

Cognitive Improvement

2 shared supplements · 324 outcomes

Cognitive improvement refers to an increase in performance on tasks of mental abilities including learning, thinking, memory, problem solving, logical reasoning, decision making, and attention.

Vulvovaginal Candidiasis (Yeast Infection)

1 shared supplement · 8 outcomes

Vulvovaginal candidiasis (VVC) is a common vaginal infection caused by species of Candida yeast. These are normal inhabitants of the vaginal microbiome, but certain contraceptives, conditions, and behaviors can disrupt the vaginal environment and lead to an overgrowth.