REVOLUTIONIZING THERAPEUTIC APPROACHES IN CHRONIC VENOUS INSUFFICIENCY: A LITERATURE REVIEW

Keywords: Chronic Venous Insufficiency, Venous Disease, Novel Treatment, Minimally Invasive Therapy, Pharmacological Therapy

Abstract

Introduction: Chronic venous insufficiency (CVI) is a prevalent, progressive vascular disorder that burdens patient health and quality of life. Current treatments: compression therapy, pharmacological agents, and surgery vary in efficacy and are often linked to poor symptom control, recurrence, or side effects. Thus, there is a need for novel therapies that improve outcomes. Recent advances in pharmacotherapy and minimally invasive methods offer promising options for enhancing venous function and symptom relief. This study critically assesses the efficacy, safety, and clinical relevance of emerging pharmacological and interventional treatments for CVI.

Material and methods: A comprehensive literature search was conducted in PubMed and Google Scholar using keywords: "chronic venous insufficiency", "venous disease", "novel treatment", "minimally invasive therapy", "pharmacological therapy". Selected studies were analyzed for therapeutic efficacy, safety, and clinical outcomes of proposed treatments.

Aim of the study To evaluate the effectiveness, safety, quality of life, and potential clinical use of novel therapies for chronic venous insufficiency.

Conclusion: Innovative drugs and minimally invasive procedures offer new alternatives for CVI, improving venous function and symptom relief. However, more high-quality clinical research is needed to confirm long-term safety, efficacy, and define optimal treatment protocols, enhancing care standards for venous disorders.

References

Santler B, Goerge T. Chronic venous insufficiency – a review of pathophysiology, diagnosis, and treatment. J Dtsch Dermatol Ges. 2017;15(5):538-556.

Miguel CB, Andrade RS, Mazurek L, Martins-de-Abreu MC, Miguel-Neto J, Barbosa AM, et al. Emerging pharmacological interventions for chronic venous insufficiency: a comprehensive systematic review and meta-analysis of efficacy, safety, and therapeutic advances. Pharmaceutics. 2025;17(1):59.

Lurie F, Branisteanu DE. Improving chronic venous disease management with micronised purified flavonoid fraction: new evidence from clinical trials to real life. Clin Drug Investig. 2023;43 Suppl 1:9-13.

Vasquez MA, Rabe E, McLafferty RB, Shortell CK, Marston WA, Gillespie D, et al. Revision of the venous clinical severity score: venous outcomes consensus statement: special communication of the American Venous Forum Ad Hoc Outcomes Working Group. J Vasc Surg. 2010;52(5):1387-1396.

Millan SB, Gan R, Townsend PE. Venous ulcers: diagnosis and treatment. Am Fam Physician. 2019;100(6):354-362.

Patel SK, Surowiec SM. Venous insufficiency. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025. Dostęp 2025-07-24. Dostępne na: https://www.ncbi.nlm.nih.gov/books/NBK430835/

Zolotukhin IA, Seliverstov EI, Shevtsov YN, Avakiants IP, Nikishkov AS, Tatarintsev AM, et al. Prevalence and risk factors for chronic venous disease in the general Russian population. Eur J Vasc Endovasc Surg. 2017;54(6):752-758.

Ellinghaus E, Ellinghaus D, Krusche P, Greiner A, Schreiber C, Nikolaus S, et al. Genome-wide association analysis for chronic venous disease identifies EFEMP1 and KCNH8 as susceptibility loci. Sci Rep. 2017;7:45636.

Salim S, Machin M, Patterson BO, Onida S, Davies AH. Global epidemiology of chronic venous disease: a systematic review with pooled prevalence analysis. Ann Surg. 2021;274(6):971-980.

Ahmadi MN, Coenen P, Straker L, Stamatakis E. Device-measured stationary behaviour and cardiovascular and orthostatic circulatory disease incidence. Int J Epidemiol. 2024;53(2):dyad020.

Vuylsteke ME, Thomis S, Guillaume G, Modliszewski ML, Weides N, Staelens I. Epidemiological study on chronic venous disease in Belgium and Luxembourg: prevalence, risk factors, and symptomatology. Eur J Vasc Endovasc Surg. 2015;49(4):432-439.

Zelle D, Klaassen G, van Adrichem E, et al. Physical inactivity: a risk factor and target for intervention in renal care. Nat Rev Nephrol. 2017;13(3):152-168.

Musil D, Kaletová M, Herman J. Venous thromboembolism – prevalence and risk factors in chronic venous disease patients. Phlebology. 2017;32(2):127-133.

Criqui MH, Denenberg JO, Bergan J, Langer RD, Fronek A. Risk factors for chronic venous disease: the San Diego population study. J Vasc Surg. 2007;46(2):331-337.

Pastori D, Cormaci VM, Marucci S, Franchino G, Del Sole F, Capozza A, et al. A comprehensive review of risk factors for venous thromboembolism: from epidemiology to pathophysiology. Int J Mol Sci. 2023;24(4):4066.

Krizanova O, Penesova A, Hokynkova A, Pokorna A, Samadian A, Babula P. Chronic venous insufficiency and venous leg ulcers: aetiology, on the pathophysiology-based treatment. Int Wound J. 2023 Oct 19. Dostępne na: https://doi.org/10.1111/iwj.14238

Barron GS, Jacob SE, Kirsner RS. Dermatologic complications of chronic venous disease: medical management and beyond. Ann Vasc Surg. 2007;21(5):652-662. Dostępne na: https://doi.org/10.1016/j.avsg.2007.03.015

Geist RS, Crane JS. Lipodermatosclerosis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025. Dostęp 2025-07-24. Dostępne na: https://www.ncbi.nlm.nih.gov/books/NBK538509

Partsch H. Varicose veins and chronic venous insufficiency. Vasa. 2009;38(4):293-301. Dostępne na: https://doi.org/10.1024/0301-1526.38.4.293

Youn YJ, Lee J. Chronic venous insufficiency and varicose veins of the lower extremities. Korean J Intern Med. 2019;34(2):269-283. Dostępne na: https://doi.org/10.3904/kjim.2018.271

Bonkemeyer Millan S, Gan R, Townsend PE. Venous ulcers: diagnosis and treatment. Am Fam Physician. 2019;100(5):298-305.

Brittenden J, Cotton SC, Elders A, Ramsay CR, Norrie J, Burr J, et al. A randomized trial comparing treatments for varicose veins. N Engl J Med. 2014;371(13):1218-1227. Dostępne na: https://doi.org/10.1056/NEJMoa1400781

Orhurhu V, Chu R, Xie K, Kamanyi GN, Salisu B, Salisu-Orhurhu M, et al. Management of lower extremity pain from chronic venous insufficiency: a comprehensive review. Cardiol Ther. 2021;10(1):111-140. Dostępne na: https://doi.org/10.1007/s40119-021-00231-2

Sugerman HJ, Sugerman EL, Wolfe L, Kellum JM, Schweitzer MA, DeMaria EJ. Risks and benefits of gastric bypass in morbidly obese patients with severe venous stasis disease. Ann Surg. 2001;234(1):41-46. Dostępne na: https://doi.org/10.1097/00000658-200107000-00007

Eberhardt RT, Raffetto JD. Chronic venous insufficiency. Circulation. 2014;130(4):333-346. Dostępne na: https://doi.org/10.1161/CIRCULATIONAHA.113.006898

Hirokawa M, Ogawa T, Sugawara H, Shokoku S, Sato S. Comparison of 1470 nm laser and radial 2ring fiber with 980 nm laser and bare-tip fiber in endovenous laser ablation of saphenous varicose veins: a multicenter, prospective, randomized, non-blind study. Ann Vasc Dis. 2015;8(4):282-289. Dostępne na: https://doi.org/10.3400/avd.oa.15-00047

Timperman PE, Sichlau M, Ryu RK. Greater energy delivery improves treatment success of endovenous laser treatment of incompetent saphenous veins. J Vasc Interv Radiol. 2004;15(10):1061-1063. Dostępne na: https://doi.org/10.1097/01.RVI.0000142182.07313.2A

Perrin M, Ramelet AA. Pharmacological treatment of primary chronic venous disease: an evidence-based review. Phlebology. 2011;26(7):281-289. Dostępne na: https://doi.org/10.1258/phleb.2011.011034

Bozkurt A, Yilmaz M. A prospective comparison of a new cyanoacrylate glue and laser ablation for the treatment of venous insufficiency. Phlebology. 2016;31(1 Suppl):106-113. Dostępne na: https://doi.org/10.1177/0268355516635381

Chaitidis N, Karkos CD, Papadopoulos G, Koudounas S, Karkos PD. Treatment of chronic venous disorder: a comprehensive review. Dermatol Ther. 2021;34(1):e14613. Dostępne na: https://doi.org/10.1111/dth.14613

Bellmunt-Montoya S, Escribano JM, Pantoja Bustillos PE, Tello-Díaz C, Martinez-Zapata MJ. CHIVA method for the treatment of chronic venous insufficiency. Cochrane Database Syst Rev. 2021;9(9):CD009648. Dostępne na: https://doi.org/10.1002/14651858.CD009648.pub3

Chastanet S, Pittaluga P. Ten-year outcomes of treatment of varicose veins by ambulatory selective ablation of varices under local anesthesia (ASVAL). J Vasc Surg Venous Lymphat Disord. 2018;6(2):289. Dostępne na: https://doi.org/10.1016/j.jvsv.2017.10.010

Kearon C, Akl EA, Ornelas J, Blaivas A, Jimenez D, Bounameaux H, et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest. 2016;149(2):315-352. Dostępne na: https://doi.org/10.1016/j.chest.2015.11.026

Juneja A, Bansal A, Syal SK, et al. Scoping review of non-thermal technologies for endovenous ablation for treatment of venous insufficiency. J Cardiovasc Surg (Torino). 2021;62(5):453-464. Dostępne na: https://doi.org/10.23736/S0021-9509.21.11761-2

Ayo D, Blumberg SN, Rockman CR, Sadek M, Cayne N, Adelman M. Compression versus no compression after endovascular ablation of the great saphenous vein: a randomized controlled trial. J Vasc Surg Venous Lymphat Disord. 2017;5(2):297. Dostępne na: https://doi.org/10.1016/j.jvsv.2016.12.002

Gibson K, Morrison N, Kolluri R, Vasquez M, Weiss R, Cher D, et al. Twenty-four month results from a randomized trial of cyanoacrylate closure versus radiofrequency ablation for the treatment of incompetent great saphenous veins. J Vasc Surg Venous Lymphat Disord. 2018;6(5):606-613. Dostępne na: https://doi.org/10.1016/j.jvsv.2018.03.013

Kheirelseid EA, Crowe G, Sehgal R, Liakopoulos D, Bela H, Mulkern E, et al. Systematic review and meta-analysis of randomized controlled trials evaluating long-term outcomes of endovenous management of lower extremity varicose veins. J Vasc Surg Venous Lymphat Disord. 2018;6(2):256-270. Dostępne na: https://doi.org/10.1016/j.jvsv.2017.10.002

Hamann SA, Timmer-de Mik L, Fritschy WM, Kuiters GRR, Nijsten TEC, van den Bos RR. Randomized clinical trial of endovenous laser ablation versus direct and indirect radiofrequency ablation for the treatment of great saphenous varicose veins. Br J Surg. 2019;106(8):998-1004. Dostępne na: https://doi.org/10.1002/bjs.11198

Schwahn-Schreiber C, Breu FX, Rabe E, Buschmann I, Döller W, Lulay GR, et al. S1 guideline on intermittent pneumatic compression (IPC). Hautarzt. 2018;69(8):662-673. Dostępne na: https://doi.org/10.1007/s00105-018-4232-2

Kärkkäinen JM. Venous insufficiency of the lower limb. Duodecim. 2017;133(6):571-572. PMID: 29243470.

Appelen D, van Loo E, Prins MH, Neumann MH, Kolbach DN. Compression therapy for prevention of post-thrombotic syndrome. Cochrane Database Syst Rev. 2017;9(9):CD004174. Dostępne na: https://doi.org/10.1002/14651858.CD004174.pub3

Gao R, Li Y, Wang Y, et al. Strategies and challenges in treatment of varicose veins and venous insufficiency. World J Clin Cases. 2023;11(1):1-13. Dostępne na: https://doi.org/10.12998/wjcc.v11.i1.1

Kim SY, Safir SR, Png CYM, Faries PL, Ting W, Vouyouka AG, et al. Mechanochemical ablation as an alternative to venous ulcer healing compared with thermal ablation. J Vasc Surg Venous Lymphat Disord. 2019;7(5):699-705. Dostępne na: https://doi.org/10.1016/j.jvsv.2019.03.011

Mohamed AH, Leung C, Wallace T, Smith G, Carradice D, Chetter I. A randomized controlled trial of endovenous laser ablation versus mechanochemical ablation with ClariVein in the management of superficial venous incompetence (LAMA Trial). Ann Surg. 2021;273(6):e188-e195. Dostępne na: https://doi.org/10.1097/SLA.0000000000004102

Oliveira RÁ, Riera R, Vasconcelos V, Baptista-Silva JC. Injection sclerotherapy for varicose veins. Cochrane Database Syst Rev. 2021;2021(12):CD001732. Dostępne na: https://doi.org/10.1002/14651858.CD001732.pub3

Techniques for endovenous laser ablation for the treatment of lower extremity chronic venous disease. UpToDate [Internet]. Dostęp 2025-07-30. Dostępne na: https://www.uptodate.com/contents/techniques-for-endovenous-laser-ablation-for-the-treatment-of-lower-extremity-chronic-venous-disease

Bontinis V, Bontinis A, Koutsoumpelis A, Chorti A, Rafailidis V, Giannopoulos A, et al. A network meta-analysis on the efficacy and safety of thermal and nonthermal endovenous ablation treatments. J Vasc Surg Venous Lymphat Disord. 2023;11(4):854-865.e5. Dostępne na: https://doi.org/10.1016/j.jvsv.2022.12.011

Witte ME, Zeebregts CJ, de Borst GJ, Reijnen MMPJ, Boersma D. Mechanochemical endovenous ablation of saphenous veins using the ClariVein: a systematic review. Phlebology. 2017;32(10):649-657. Dostępne na: https://doi.org/10.1177/0268355516683807

Morrison N, Gibson K, Vasquez M, Weiss R, Jones A. Five-year extension study of patients from a randomized clinical trial (VeClose) comparing cyanoacrylate closure versus radiofrequency ablation for the treatment of incompetent great saphenous veins. J Vasc Surg Venous Lymphat Disord. 2020;8(6):978-989. Dostępne na: https://doi.org/10.1016/j.jvsv.2020.02.013

Almeida JI, Kabnick LS, Dalsing MC, et al. Treatment of superficial venous reflux with endovenous laser ablation versus radiofrequency ablation: a randomized clinical trial. N Engl J Med. 2018;378(12):1126-1135.

Published
2025-12-30
Citations
How to Cite
Bartłomiej Czarnecki, Jan Nowak, Illia Koval, Bartosz Zwoliński, Kacper Sukiennicki, Wirginia Bertman, Natalia Kołdej, Zuzanna Kępczyńska, Wiktor Kubik, Katarzyna Szewczyk, Kamil Borysewicz, & Klaudia Romejko. (2025). REVOLUTIONIZING THERAPEUTIC APPROACHES IN CHRONIC VENOUS INSUFFICIENCY: A LITERATURE REVIEW. International Journal of Innovative Technologies in Social Science, 2(4(48). https://doi.org/10.31435/ijitss.4(48).2025.4213

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