French maritime pine bark for chronic venous insufficiency.
Article Type: Report
Subject: Venous insufficiency (Care and treatment)
Venous insufficiency (Research)
Materia medica, Vegetable (Usage)
Materia medica, Vegetable (Health aspects)
Materia medica, Vegetable (Chemical properties)
Materia medica, Vegetable (Research)
Plant extracts (Usage)
Plant extracts (Health aspects)
Plant extracts (Chemical properties)
Plant extracts (Research)
Author: Finney-Brown, Tessa
Pub Date: 12/22/2010
Publication: Name: Australian Journal of Medical Herbalism Publisher: National Herbalists Association of Australia Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2010 National Herbalists Association of Australia ISSN: 1033-8330
Issue: Date: Winter, 2010 Source Volume: 22 Source Issue: 4
Topic: Event Code: 310 Science & research
Geographic: Geographic Scope: Australia Geographic Code: 8AUST Australia
Accession Number: 254971800
Full Text: Cesarone M, Belcaro G, Rohdewald P, Pellegrini L, Ledda A, Vinciguerra G et al. 2010. Improvement of signs and symptoms of chronic venous insufficiency and microangiopathy with Pycnogenol[R]. Phytomed 17:12;835-9.

Chronic venous insufficiency (CVI) is a common condition of decreased venous return resulting from dysfunctional valves. An extract of Pinus pinaster Ait (maritime pine) known as Pycnogenol[R] (which is standardised to contain 70[+ or -]5% procyanidins) has been extensively used and researched for the treatments and prevention of this condition and its complications. It has been shown to control increased capillary permeability in the microangiopathy associated with CVI, prevent edema and is anti-inflammatory and antiplatelet, with beneficial flow on effects for venous pressure.

The current study utilised this extract in order to assess its efficacy in relieving the symptoms of CVI in volunteers with severe venous insufficiency and microangiopathy. Ninety eight volunteers with severe longstanding CVI were recruited and randomised into three groups which were comparable in age and gender make up. Upon inclusion, all were found to have significantly increased ambulatory venous pressure associated with incompetence of the deep venous system.

Two groups of patients received Pycnogenol[R] capsules (50 mg) thrice daily for eight weeks. One group used this in combination with compression stockings, and the other used only the herbal extract. The third and final group received no medication and used only compression stockings. These stockings were below knee height, with a pressure of 25 mmHg compression at the ankle and were worn for at least 10 hours daily during activity hours.

Researchers assessed microcirculatory measurements via strain gauge plethysmography (a test which quantifies capillary filtration at the ankle) and laser Doppler flowmeters. There was also a score for evaluation of clinical symptoms and signs including edema, pain, restless limbs, subjective swelling and skin redness or alterations. These symptoms were patient rated on a VAS and investigators assessed the severity with the aid of a venous clinical severity score. Disability was judged according to a 4-scale venous disability score.

Following eight weeks of treatment the combination group showed a significantly greater decrease in resting flux than the other two groups (who also displayed improvements in this measure). The Pygnogenol[R] alone was more effective than compression alone in this regard. There was also a significant increase in transcutaneous [pO.sub.2] respiration in both herbal groups, but a decrease in this measure with compression treatment alone. Capillary filtration significantly decreased, symptomatic scores on the analogue scale significantly improved, clinical severity scores dropped and the venous disability score was improved in all three groups, with all parameters improved most by combination treatment, then Pycnogenol[R], then compression treatment alone.

Use of this standardised French maritime pine extract had beneficial effects on both signs and symptoms of CVI in those with severe venous insufficiency and microangiopathy. In comparison to compression treatment it was proven more effective, probably due to the ability to physiologically reduce increased capillary filtration rather than simply shift the physical site of edema. In conclusion the study proves the benefits of Pycnogenol[R] in the management and treatment of edema and other signs and symptoms of CVI.

Tessa Finney-Brown MNHAA
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