Pharmacotherapy of chronic venous disease-how to choose appropriate venoactive drug?

Abstract

Chronic venous disease (CVD) is a multicomponent process that develops with time as a consequence of hemodynamic changes of macro- and microcirculation. The shear stress shift leads to leukocytes and macrophages activation and proinflammatory mediators (including ICAM-1, VEGF, MMP) secretion and smooth muscle cells switching to the secretory type. The cascade of the inflammatory reactions causes venous wall remodeling, increasing the wall permeability and protein and fluid extravasation. Proinflammatory mediators activate nociceptors between endothelial and muscle cells. All those processes result in venous symptoms developing such as venous pain, oedema, legs heaviness and others well-known symptoms. Contemporary conceptions of chronic venous disease progression pathophysiological mechanisms allow us to determine possible effective therapeutic targets to reduce the degree of symptoms and signs manifestation. Venoactive drugs that nowadays are widely spread on the pharmaceutical market demonstrate varied effectiveness against different symptoms. Results of multipal investigations including metanalyses help us to define grades of recommendations for every venoactive drug and to individualize the treatment of patients according to the types of symptoms. Modern modifications of topical drugs with the help of adding essential phospholipids acting like transdermal delivery system enhance the effectiveness and help to reduce the severity of clinical manifistations of CVD especially in combination with venoactive drugs.