Orthostatic-loading-induced transient venous refluxes (day orthostatic loading test), and remedial effect of micronized purified flavonoid fraction in patients with telangiectasia and reticular vein.

Background: Orthostatic loading can induce transient venous reflux (TVR). Among patients with telangiectasia and reticular varices, we determined the proportion that developed TVR after a day of orthostatic loading (DOL test), and investigated the remedial effects of micronized purified flavonoid fraction (MPFF).

Methods: All 96 patients enrolled in this study had telangiectasia and reticular varices. Patients underwent duplex scanning (DS) in the morning and evening, and vein diameters were measured. Patients with detectable evening TVR were treated daily with MPFF (Daflon® 1000 mg; Servier, Suresnes, France) for 90 days, and then reassessed. Patient quality of life (QOL) was evaluated using the Chronic Venous Insufficiency Questionnaire (CIVIQ-20).

Results: At baseline, patients had telangiectasia (45.8%), reticular varices (13.5%), or both (40.7%). TVR was absent in all patients in the morning but present in over half of them (55.2%) in the evening. All TVR patients complained of leg heaviness versus 16.3% of non-TVR patients. The great saphenous vein (GSV) diameters of patients with TVR were significantly greater than those without (Р<0.0001). After MPFF treatment, TVR was eliminated in most patients (92.5%). The GSV diameter in treated patients was significantly reduced from baseline (5.69-5.14 mm; Р=0.000001). The majority of patients (88.6%) no longer experienced leg heaviness, with 11.4% having reduced symptoms. QOL improved.

Conclusions: More than half of the patients with telangiectasia and reticular varices experience TVR. TVRs can be exposed using the DOL test, which has no impact upon daily life. Daily MPFF (Daflon® 1000 mg) treatment over 90 days eliminated TVR, resolved venous symptoms, and improved QOL.