How does Venastat horse chestnut extract promote leg vein health. What are the benefits of using Venastat for tired and swollen legs. Why is Venastat considered a safe and effective natural supplement for leg circulation.

Understanding Venastat: A Natural Approach to Leg Vein Health

Venastat is a dietary supplement designed to provide nutritive support for leg vein health and circulation. This all-natural formula contains horse chestnut extract and diosmin, two key ingredients that work synergistically to address common leg discomfort issues.

The primary component, horse chestnut extract, is standardized to 16.7% Escin, matching the concentration used in numerous published clinical studies. This standardization ensures consistency and efficacy in every dose.

Key Benefits of Venastat

• Helps relieve tired or swollen legs
• Promotes leg circulation
• Strengthens capillaries
• Maintains natural fluid balance in legs

The Science Behind Venastat’s Effectiveness

Venastat’s formula is rooted in scientific research and traditional herbal medicine. The horse chestnut extract, rich in Escin, has been shown to improve venous tone and reduce capillary permeability. This action helps prevent fluid accumulation in the surrounding tissues, which often leads to swelling and discomfort.

How does Escin work in the body? Escin, the active compound in horse chestnut extract, has anti-inflammatory and venotonic properties. It helps strengthen the walls of blood vessels, reducing their permeability and preventing fluid leakage. This mechanism of action directly addresses the root cause of many leg vein issues.

The Role of Diosmin in Venastat

Diosmin, a bioflavonoid derived from sweet orange, complements the action of horse chestnut extract. It provides additional support for veins, microcirculation, and lymphatic flow. This combination enhances the overall effectiveness of Venastat in promoting leg vein health.

Who Can Benefit from Venastat?

Venastat is particularly beneficial for individuals experiencing:

• Achy, tired legs
• Swollen legs
• Poor leg circulation
• Discomfort from prolonged standing or sitting

Is Venastat suitable for everyone? While Venastat is generally safe for most adults, it’s always recommended to consult with a healthcare professional before starting any new supplement regimen, especially if you have pre-existing medical conditions or are taking other medications.

Optimal Usage and Dosage Guidelines

To achieve the best results with Venastat, it’s important to follow the recommended dosage and usage instructions:

1. Take up to two capsules daily
2. Consume with water before a meal
3. Continue use for at least four weeks for optimal benefits
4. Store in a cool, dry place

Why is consistent use important? Venastat works by gradually improving vein health and circulation. Continuous use for at least four weeks allows the active ingredients to build up in your system and provide lasting benefits.

Safety and Quality Assurance

Venastat is manufactured in the USA under strict quality control measures. The product comes in a tamper-evident blister sheet to ensure safety and integrity. It’s important to note that if the foil or plastic is punctured, the product should not be used.

Natural Ingredients for Peace of Mind

The supplement contains only natural ingredients, including:

• Horse chestnut extract
• Diosmin
• Gelatin (capsule)
• Magnesium stearate
• Silica
• Carmine

Are there any known side effects of Venastat? While Venastat is generally well-tolerated, as with any supplement, some individuals may experience mild side effects. It’s always best to start with a lower dose and monitor your body’s response.

Comparing Venastat to Other Leg Vein Health Solutions

Venastat stands out in the crowded market of leg vein health supplements due to its unique formulation and scientific backing. Unlike many over-the-counter options, Venastat’s horse chestnut extract is standardized to match the concentration used in clinical studies.

Advantages of Venastat

• All-natural formula
• Clinically studied ingredients
• Dual-action with horse chestnut and diosmin
• Non-invasive solution for leg vein health

How does Venastat compare to compression stockings? While compression stockings offer external support, Venastat works from within to improve vein health and circulation. Many users find that combining Venastat with external methods like compression stockings or regular exercise yields the best results.

Lifestyle Tips to Enhance Venastat’s Effectiveness

While Venastat can significantly improve leg vein health on its own, combining it with healthy lifestyle habits can amplify its benefits:

1. Regular exercise, especially walking or swimming
2. Maintaining a healthy weight
3. Elevating legs when resting
4. Avoiding prolonged periods of sitting or standing
5. Staying hydrated

Can dietary changes improve leg vein health? Absolutely. A diet rich in flavonoids (found in berries, citrus fruits, and leafy greens) and low in sodium can support overall vascular health. These dietary choices complement the action of Venastat, potentially leading to even better results.

Understanding the Long-Term Benefits of Venastat

While Venastat provides relief from immediate symptoms like tired and swollen legs, its long-term benefits are equally impressive. Regular use of Venastat can contribute to overall vascular health, potentially reducing the risk of more serious venous issues in the future.

Preventive Benefits of Venastat

• Strengthens vein walls over time
• Improves overall circulation
• Reduces risk of venous insufficiency
• Supports lymphatic system function

How long should one continue using Venastat? For individuals with chronic leg vein issues or those at high risk due to lifestyle or genetics, long-term use of Venastat under the guidance of a healthcare professional can be beneficial. However, it’s always advisable to reassess your needs periodically with your doctor.

Venastat for Different Age Groups and Lifestyles

Leg vein health is a concern that spans across various age groups and lifestyles. Venastat’s versatility makes it suitable for a wide range of individuals:

Young Adults

For those in desk jobs or professions requiring long periods of standing, Venastat can provide preventive care and relief from early signs of leg vein issues.

Middle-Aged Adults

As the risk of venous problems increases with age, Venastat offers a proactive approach to maintaining leg vein health and comfort.

Seniors

Older adults, who are more prone to circulatory issues, may find Venastat particularly beneficial in managing leg discomfort and promoting overall vascular health.

Athletes and Fitness Enthusiasts

Even active individuals can benefit from Venastat, especially in recovery and maintaining leg health during periods of intense training.

Is Venastat suitable for pregnant women? While the ingredients in Venastat are natural, pregnant women should always consult with their healthcare provider before starting any new supplement regimen, including Venastat.

Combining Venastat with Other Health Supplements

Venastat’s natural composition makes it generally safe to use alongside other health supplements. However, it’s important to consider potential interactions and overall health goals when combining supplements.

Complementary Supplements

• Omega-3 fatty acids for overall cardiovascular health
• Vitamin C to support collagen production and vein strength
• Grape seed extract for additional antioxidant support

Can Venastat be taken with prescription medications? While Venastat is a natural supplement, it’s crucial to inform your healthcare provider about all supplements you’re taking, especially if you’re on prescription medications. Some natural compounds can interact with medications, affecting their efficacy or potentially causing side effects.

The Future of Leg Vein Health: Venastat and Beyond

As research in vascular health continues to advance, supplements like Venastat are likely to evolve and improve. The growing interest in natural health solutions suggests that plant-based compounds like horse chestnut extract and diosmin will continue to play a significant role in managing leg vein health.

Emerging Research

Ongoing studies are exploring new applications of horse chestnut extract and diosmin, potentially expanding their use in various aspects of vascular health. This research may lead to even more targeted and effective formulations in the future.

Personalized Approaches

The trend towards personalized medicine may soon extend to supplements like Venastat, with formulations tailored to individual needs based on genetic profiles, lifestyle factors, and specific health concerns.

Will there be new innovations in leg vein health supplements? It’s highly likely. As our understanding of vascular biology deepens, we can expect to see new ingredients and formulations that target leg vein health even more effectively. Venastat’s current formula, however, remains at the forefront of natural leg vein support based on current scientific evidence.

Customer Experiences and Testimonials

While individual experiences can vary, many users report positive outcomes with Venastat. Common feedback includes:

• Reduced leg swelling and discomfort
• Improved energy levels throughout the day
• Greater comfort during long periods of standing or sitting
• Noticeable improvements in leg appearance over time

How quickly do users typically see results with Venastat? Many users report feeling initial improvements within a few weeks of consistent use. However, the full benefits are often realized after 4-6 weeks of regular supplementation, as indicated in the product guidelines.

Purchasing and Availability of Venastat

Venastat is widely available through various retail channels, including online marketplaces like Amazon and local pharmacies. The product often comes in different package sizes, with bonus packs offering better value for long-term users.

Considerations When Purchasing

• Check for authenticity when buying online
• Compare prices across different retailers
• Look for bundle deals or subscription options for regular users
• Ensure the product is not expired or damaged before use

Is Venastat covered by health insurance? As a dietary supplement, Venastat is typically not covered by standard health insurance plans. However, some flexible spending accounts (FSAs) or health savings accounts (HSAs) may allow for the purchase of certain supplements. It’s best to check with your specific plan for details.

Addressing Common Misconceptions About Leg Vein Health

There are several myths surrounding leg vein health that Venastat helps to address:

Myth 1: Leg Vein Issues Only Affect Older Adults

Reality: While more common in older individuals, leg vein problems can affect people of all ages, especially those with certain lifestyles or genetic predispositions.

Myth 2: Only External Treatments Are Effective

Reality: Internal supplements like Venastat can be highly effective in improving leg vein health from within, often complementing external treatments.

Myth 3: Leg Vein Health Is Only About Appearance

Reality: While aesthetic concerns are valid, leg vein health is crucial for overall circulation and can impact general well-being and quality of life.

Can lifestyle changes alone solve leg vein issues? While a healthy lifestyle is crucial for vein health, some individuals may benefit from additional support like Venastat, especially if they have genetic predispositions or unavoidable lifestyle factors that impact their leg vein health.

Integrating Venastat into Your Daily Wellness Routine

Incorporating Venastat into your daily health regimen can be simple and effective. Here are some tips for seamless integration:

1. Set a daily reminder to take Venastat at the same time each day
2. Pair it with other daily supplements or vitamins for convenience
3. Keep a journal to track improvements in leg comfort and appearance
4. Combine Venastat use with regular leg exercises or stretches
5. Stay consistent with use, even on days when symptoms may be less noticeable

How can one maximize the benefits of Venastat? Consistency is key. Taking Venastat regularly as part of a holistic approach to leg health, including proper diet, exercise, and lifestyle adjustments, can lead to optimal results. Remember, leg vein health is a long-term commitment, and Venastat is a valuable tool in maintaining it.

Venastat Horse Chestnut Extract, Capsules (60 each) Delivery or Pickup Near Me

Venastat Horse Chestnut Extract, Capsules (60 each) Delivery or Pickup Near Me – Instacart

Free delivery on first 3 orders. Terms apply.

Departments

More ways to shop

Fast delivery

Get in as fast as 1 hour

It’s all local

Shop your favorites

Direct chat

Connect with shoppers

Use Next and Previous buttons to navigate

60 each

60 each

100% satisfaction guarantee

Place your order with peace of mind.

Kitchen Tropical Mango Veggie Smoothie

Recent reviews

Jun 2023

Order delivered in 30 min

Smart bagging

Quality items

Extra effort

Customer since 2022

San Francisco, CA

Jun 2023

Order delivered in 37 min

Extra effort

Smart bagging

Quality items

Customer since 2022

San Francisco, CA

Jun 2023

Order delivered in 41 min

Quality items

Extra effort

Smart bagging

Customer since 2016

San Francisco, CA

About

Details

Dietary Supplement. Natural leg vein health. Helps relieve tired or swollen legs. Promotes leg circulation. Safe & effective. All natural. Improved formula with diosmin. What is Venastat? The Venastat formula is intended to provide nutritive support to help relieve tired or swollen legs and promote leg vein health and circulation. Why take Venastat? For many people, achy, tired or swollen legs are an all-too-common part of their daily lives. Standing or sitting for long periods of time, being physically inactive and even natural aging can make it more difficult for your body to maintain good leg vein health – to efficiently circulate blood from your legs to your heart. Fluid can collect in the legs and pass from the capillaries into surrounding tissue. As a result, your legs can feel achy, heavy or tired. How does it work? The Venastat formula is intended to provide nutritive support to help strengthen capillaries and maintain a natural fluid balance in the legs. What makes it special? The Venastat formula contains a horse chestnut extract which is standardized to 16. 7% Escin-The same level of standardization used in numerous published clinical studies. What is Diosmin? Diosmin is a bioflavonoid derived from sweet orange and is intended to provide nutritive support for veins, micro circulation, and lymphatic flow. Made in the USA.

Ingredients

Other Ingredients: Gelatin (Capsule), Magnesium Stearate, Silica, Carmine.

Directions

Use only as directed. Adults should take up to two capsules daily with water before a meal. Best results are achieved with four weeks of continuous use. Store in a cool, dry place.

Warnings

Keep out of reach of children. Keep your licensed health care practitioner informed when using this product. This product has a tamer-evident blister sheet. Do not use if foil or plastic is punctured.

About

Details

Dietary Supplement. Natural leg vein health. Helps relieve tired or swollen legs. Promotes leg circulation. Safe & effective. All natural. Improved formula with diosmin. What is Venastat? The Venastat formula is intended to provide nutritive support to help relieve tired or swollen legs and promote leg vein health and circulation. Why take Venastat? For many people, achy, tired or swollen legs are an all-too-common part of their daily lives. Standing or sitting for long periods of time, being physically inactive and even natural aging can make it more difficult for your body to maintain good leg vein health – to efficiently circulate blood from your legs to your heart. Fluid can collect in the legs and pass from the capillaries into surrounding tissue. As a result, your legs can feel achy, heavy or tired. How does it work? The Venastat formula is intended to provide nutritive support to help strengthen capillaries and maintain a natural fluid balance in the legs. What makes it special? The Venastat formula contains a horse chestnut extract which is standardized to 16.7% Escin-The same level of standardization used in numerous published clinical studies. What is Diosmin? Diosmin is a bioflavonoid derived from sweet orange and is intended to provide nutritive support for veins, micro circulation, and lymphatic flow. Made in the USA.

Ingredients

Other Ingredients: Gelatin (Capsule), Magnesium Stearate, Silica, Carmine.

Directions

Use only as directed. Adults should take up to two capsules daily with water before a meal. Best results are achieved with four weeks of continuous use. Store in a cool, dry place.

Warnings

Keep out of reach of children. Keep your licensed health care practitioner informed when using this product. This product has a tamer-evident blister sheet. Do not use if foil or plastic is punctured.

Why Instacart?

Delivery in as little as 2 hours

Shop local stores at great prices

Get high-quality items you love

Common questions

It’s simple. Using the Instacart app or website, shop for products from your store of choice near you.

Once you place your order, Instacart will connect you with a personal shopper in your area to shop and deliver your order. Contactless delivery is available with our “Leave at my door” option. You can track your order’s progress and communicate with your shopper every step of the way using the Instacart app or website.

Learn more about how to place an order here.

Using the Instacart app or website, select a store of your choice near you that offers pickup, select Pickup, and then select your preferred pickup location from which you’d like to place your order.

Then, when you arrive at the store of your choice, use the Instacart app to notify us. Depending on the store, a shopper or store employee will bring the groceries to your car, or you can pick them up at the designated area.

Learn more about pickup orders here.

Here’s a breakdown of Instacart delivery cost:

– Delivery fees start at $3.99 for same-day orders over $35. Fees vary for one-hour deliveries, club store deliveries, and deliveries under $35.
– Service fees vary and are subject to change based on factors like location and the number and types of items in your cart. Orders containing alcohol have a separate service fee.
– Tipping is optional but encouraged for delivery orders. It’s a great way to show your shopper appreciation and recognition for excellent service. 100% of your tip goes directly to the shopper who delivers your order.

With an optional Instacart+ membership, you can get $0 delivery fee on every order over $35 and lower service fees too.

Instacart pickup cost:
– There may be a “pickup fee” (equivalent to a delivery fee for pickup orders) on your pick up order that is typically $1.99 for non-Instacart+ members. Instacart+ membership waives this like it would a delivery fee.
– Pick up orders have no service fees, regardless of non-Instacart+ or Instacart+ membership.

Learn more about Instacart pricing here.

Venastat Horse Chestnut Extract With Diosmin

USD

US Dollar

EURO

Australia

Brazil Real

Canadian Dollar

Hong Kong Dollar

Japan Yen

Switzerland Franc

United Kingdom Pound

Ukraine Hryvnia

Thailand Baht

Sweden Krona

South Africa Rand

Singapore Dollar

Russia Ruble

Norway Krone

Netherlands Antilles Guilder

Mexico Peso

Jamaica Dollar

ALAN JAMES GROUP, LLC

$27. 99

Venastat Horse Chestnut Extract Capsules Dietary Supplement, With Diosmin

• Promotes leg vein health and circulation.
• Provides nutritive support to help strengthen capillaries.
• Maintains a natural fluid balance in the legs.
• Contains a Horse Chestnut Extract which is standardized to 16.7% Escin.
• Diosminis a bioflavonoid derived from sweet orange, provides nutritive support for veins, micros circulation, and lymphatic flow.

Ingredients:

• Gelatin (Capsule), Magnesium Stearate, Silica, Carmine.

Warnings:

• This product has a tamper-evident blister sheet. Do not use if or plastic is punctured. Keep out of reach of children. Keep licensed health care practitioner informed when using this product.

Please read all label information carefully on delivery and prior to use.

Read more

Current stock

0

• Description

• Reviews (0)

• Additional info

Description

Venastat Horse Chestnut Extract Capsules Dietary Supplement, With Diosmin

• Promotes leg vein health and circulation.
• Provides nutritive support to help strengthen capillaries.
• Maintains a natural fluid balance in the legs.
• Contains a Horse Chestnut Extract which is standardized to 16.7% Escin.
• Diosminis a bioflavonoid derived from sweet orange, provides nutritive support for veins, micros circulation, and lymphatic flow.

Ingredients:

• Gelatin (Capsule), Magnesium Stearate, Silica, Carmine.

Warnings:

• This product has a tamper-evident blister sheet. Do not use if or plastic is punctured. Keep out of reach of children. Keep licensed health care practitioner informed when using this product.

Please read all label information carefully on delivery and prior to use.

Reviews (0)

Be the first to write a review

Additional info

SKU:
10045738

UPC:
793190090158

Width:
5. 00

Height:
4.00

Depth:
4.00

Shipping:
Calculated at Checkout

Pharmacotherapy of chronic venous diseases. What do we know about horse chestnut extract? | Bogachev V.Yu., Boldin B.V., Kuznetsov M.R., Rodionov S.V.

The article is devoted to the pharmacotherapy of chronic diseases of the veins of the lower extremities. The effectiveness of horse chestnut extract is considered.

Chronic venous disease (CVD) of the lower extremities is the most common cardiovascular pathology, occurring in more than half of the adult population of industrialized countries. Vein-specific symptoms and syndromes significantly reduce the social activity of patients with CVD and their quality of life. Phlebotropic drugs, along with lifestyle modification and compression therapy, are currently considered as a mandatory component of the complex treatment and rehabilitation of patients with CVD.

Horse chestnut seed extract and pharmacological preparations from it have been successfully used in clinical practice for more than two centuries to treat chronic hemorrhoids, post-traumatic and post-operative edema, as well as CVD of the lower extremities. In the latter case, horse chestnut seed extract showed the best therapeutic results, thanks to which it was included in the line of modern phleboprotectors.

In the Russian Federation, the combined drug Aescusan is registered, which includes a purified extract of horse chestnut seeds and thiamine hydrochloride – vitamin B ₁ .

Purified horse chestnut seed extract ( Aesculus hippocastanum ) contains a mixture of pharmacologically active substances: saponins, bioflavonoids, antioxidants and coumarins. Saponins, in particular beta-aescin (syn.: escin), determines the main phleboprotective effect of Aescusan, which is potentiated by bioflavonoids – quercetin, kaempferol and their derivatives. Proanthocyanidin A2 acts as an antihypoxant, and coumarins (esculin, fraxin) have a moderate hypocoagulant effect [1, 2].

Another component that is part of Aescusan is thiamine hydrochloride (vitamin B ₁ ). The daily requirement of an adult for thiamine is 1. 5-2 mg, but may vary depending on various factors. It should be noted that thiamine is rapidly destroyed by heating, therefore, when preparing dishes from foods containing vitamin B ₁ , most of its beneficial properties are lost. Thiamine plays an important role in carbohydrate, protein and fat metabolism, as well as in the processes of nerve excitation in synapses. In relation to CVD, vitamin B ₁ protects cell membranes from the toxic effects of peroxidation products, slows down the aging process, maintains the tone of the smooth muscles of the vascular wall and cardiomyocytes. Vitamin B deficiency ₁ is manifested by increased fatigue, weakness and pain in the calf muscles, as well as a tendency to peripheral edema [3].

Due to the combined composition, Aescusan has anti-edematous, anti-inflammatory and phlebotonizing effects, which are realized through various molecular and cellular mechanisms, some of which have already been well studied. In particular, an increase in the tone and contractile activity of the venous wall is associated with an improvement in the selective permeability of slow calcium channels in myocytes, which, as a clinical outcome, is manifested by a decrease in vein-specific symptoms and edema [4].

The additional anti-edematous effect of Aescusan is associated with the stabilization of the vascular wall and the suppression of endothelial dysfunction. The latter occurs as a result of endothelial hypoxia against the background of venous stasis. Endothelial hypoxia is currently considered as one of the key pathogenetic mechanisms for the development and progression of diseases of the cardiovascular system in general and CVD in particular.

Hypoxia of the venous endothelium leads to a deterioration in mitochondrial “respiration” with a decrease in the production of adenosine triphosphate (ATP), a universal energy source for various biochemical processes inside the cell. ATP deficiency reorients intracellular metabolism to the hypoxic pathway, which results in the release of prostaglandins and platelet-activating factor.

In response to chronic hypoxia, the endothelium expresses cell adhesion molecules, leading to the activation of neutrophils and macrophages, which become additional factors for damage to the walls of venous capillaries with increased interstitial edema. The biologically active substances that make up Aescusan prevent the development of intracellular hypoxia, maintain the physiological levels of ATP and phospholipase A2, which is responsible for the release of pro-inflammatory messengers, and also prevent the activation and adhesion of neutrophils, protecting the wall of venous capillaries from leukocyte aggression and normalizing its permeability [5] .

The anti-edematous effect of horse chestnut extract is confirmed by various randomized clinical trials (RCTs). One of them, with the imposition of a pneumatic cuff on the thigh in patients with CVD to further increase venous pressure, demonstrated a decrease in capillary filtration by 22% in patients receiving the drug, while interstitial edema increased in the placebo group [4].

As noted above, the main phleboprotective effect has beta-aescin, which is part of Aescusan, which can suppress the activity of elastase and hyaluronidase. Elastase and hyaluronidase are enzymes actively involved in the destruction of proteoglycans, which are important structural components of the endothelium and extracellular matrix. It has been experimentally proven that aescin shifts the metabolism of proteoglycans towards synthesis and thereby strengthens the capillary wall and prevents extravasation of the liquid part of the plasma [6].

The anti-inflammatory mechanism of horse chestnut seed extract is not well understood. At the same time, its antipyretic and analgesic clinical effect is known. A relatively small amount of experimental data, the most interesting of which are the involution of the inflammatory granuloma and the dose-dependent decrease in the number of leukocytes in the exudate from the trophic ulcer, suggests that Aescusan suppresses the cellular phase of inflammation. This statement confirms the suppression of the synthesis of pro-inflammatory mediators leading to the activation of leukocytes and their transendothelial migration against the background of the use of aescin [7].

In experiments, aescin significantly increased and prolonged the sensitivity of isolated varicose veins, as well as their contractility under the action of norepinephrine. It is important that an increase in the contractile capacity of the venous wall by 10–20% was observed at sufficiently low concentrations of aescin, which can be easily and safely achieved by prescribing preparations based on horse chestnut seed extract per os [8, 9].

As a rule, modern drugs derived from horse chestnut seed extract, including Aescusan, are well tolerated. Previous reports of seed poisoning Aesculus hippocastanum concerned the artisanal production of an extract from them, which included the toxic substance esculoside.

Aescusan, even with long-term use, does not adversely affect reproductive function and fertility in men and women, and does not provoke any adverse effects in offspring.

Indications for use in patients with various forms of CVD and their complications of Aescusan are based on its venotonic, anti-inflammatory, capillary-protective and anti-edematous effects due to a complex, not fully understood molecular and cellular mechanism [10-14].

The main indications for prescribing drugs based on horse chestnut extract, including Aescusan, are complaints associated with CVD, as well as chronic venous edema.

The efficacy of vein-specific symptoms such as pain, itching, sensation of swelling, and edema proper with horse chestnut extract was analyzed in 10 placebo-controlled RCTs included in a Cochrane systematic review.

In 7 RCTs, the main criterion was the dynamics of pain in the calf muscles against the background of CVD. Six of these RCTs demonstrated significant reductions in pain scores in patients treated with horse chestnut extract compared with placebo. Another 1 RCT reported a significant reduction in calf pain from baseline. The NNT score for venous pain was 5.1, with a high level of evidence (grade A). The effectiveness of horse chestnut extract on pruritus was studied in 8 RCTs, 4 of which showed a statistically significant reduction in this highly unpleasant symptom with horse chestnut seed extract compared with placebo (NNT 6.1), and another 2 RCTs showed a statistically significant reduction initial level. The level of evidence is high (class A). Edema was assessed in 6 RCTs. Four studies reported a statistically significant reduction in lower leg swelling in patients treated with horse chestnut seed extract compared with placebo. Another 1 RCT documented a significant reduction in baseline edema. The NNT for horse chestnut seed extract in the treatment of edema in CVD was 4.0, with a high level of evidence (grade A). Measurement of leg volume with a water immersion volumemeter was used in 7 placebo-controlled RCTs on horse chestnut extract. A meta-analysis of 6 of them found a clear advantage of the drug over placebo. The level of evidence is high (class A) [15].

Eight RCTs studied various doses and regimens of preparations based on horse chestnut seed extract, it was shown that taking 100-150 mg of aescin 2 times a day for 2-8 weeks. enough to significantly reduce the volume of the lower leg and the severity of vein-specific symptoms with a casuistically rare frequency of adverse reactions that does not differ from placebo [16–18].

Of great clinical interest are the very ambiguous results of RCT, during which patients with chronic venous edema for 12 weeks. received either horse chestnut extract or compression therapy (stockings class 2 RAL standard) or placebo. Patients assigned to the compression therapy group received a diuretic for 7 days at the stage of selecting compression stockings. The primary endpoint for assessing the effectiveness of treatment options was the logarithmic measure of lower extremity volume measured after 12 weeks. treatment. As a result, the average volume of the legs in the group of patients treated with horse chestnut seed extract and compression therapy decreased by 43. 8±11.4 ml and 46.7±8.2 ml, respectively. In the placebo group, edema increased by 9.8±15.0 ml. Based on the results of this RCT, the authors made the very bold conclusion that the therapeutic efficacy of horse chestnut extract and compression therapy for chronic venous edema is comparable and significantly better than placebo. In continuation of the development of this topic, a proposal was made to prescribe phlebotropic drugs to patients with low adherence to regular wearing of compression stockings [19].

To select the pharmacological regimen for the treatment of CVD, RCTs are relevant, in which a comparative assessment of the horse chestnut seed extract with other widely used phlebotropic drugs is carried out. There are 4 RCTs that compared aescin (50-75 mg 2 times a day) and hydroxyethyl rutoside (HER) in a daily dose of 500 to 2000 mg. Both groups achieved good clinical results without significant statistical differences [20].

Since CVD is 3–4 times more common in women, a gender assessment of the results of phlebotropic therapy becomes clinically important. So, in a double-blind RCT with the inclusion of 137 postmenopausal women divided into 2 groups, 2 regimens for the use of GER 1000 mg / day were compared for the entire treatment period: 1000 mg / day for 4 weeks, then 500 mg / day for another 8 weeks . with the intake of aescin 50 mg 2 r./day. The treatment period was preceded by a 2-week placebo wash-out period followed by a 6-week no-medication follow-up. The diagnosis of CVD and associated edema was confirmed by ultrasound in all patients. The dynamics of the main clinical indicator, edema, was assessed by measuring the volume of displaced water at each visit after 4, 8, and 12 weeks. against the background of ongoing treatment, as well as after 15 and 18 weeks. during the observation period. Horse chestnut extract showed similar efficacy to GER, despite a small, non-significantly larger decrease in volume with the latter. At the same time, patients who received horse chestnut extract noted better dynamics of subjective vein-specific symptoms and drug tolerance [21].

In 1996, a large observational study was conducted in Germany, in which 800 general practitioners took part, evaluating the effect of horse chestnut seed extract on vein-specific symptoms in 5429 patients with various forms of CVD and their complications. The vast majority of patients received the drug at a dose of 75 mg 2 times a day for 4-10 weeks. Positive dynamics in terms of CVD symptoms was noted as early as the 1st week. treatment and gradually increased throughout the period of therapy. Treatment adherence approached 95%, and good or excellent therapeutic efficacy of horse chestnut seed extract was recorded in 94% of patients [22].

The data presented above strongly suggest that CVD-associated symptoms and edema can be effectively controlled with drugs based on horse chestnut extract.

With regard to safety, according to the results of known RCTs, the frequency of unwanted side effects that occur while taking drugs derived from horse chestnut seed extract does not exceed 3% and was comparable to that of placebo. In most cases, undesirable side effects were manifested in the form of dyspepsia, dizziness, headache and pruritus. Isolated cases of severe toxic-allergic reactions have been described [22].

Preparations derived from horse chestnut extract are indicated in current recommendations for the treatment of CVD. In particular, in the guidelines of the American Venous Forum, updated in 2017, aescin, among other phlebotropic drugs, is proposed to be used in addition to compression therapy in the presence of various vein-specific symptoms [23]. In the European clinical guidelines (2018), horse chestnut extract with evidence level A is considered as the drug of choice for pain and edema associated with CVD [24].

In conclusion, it should be noted that modern phlebotropic therapy is an important and integral component of the conservative treatment of CVD and its complications. At the same time, despite the large number of drugs used for this purpose, only some of them have been tested by time and studied in a variety of experimental and clinical studies.