Fixed-dose ruscus extract combination and its place in current clinical guidelines for the treatment of chronic venous diseases

Chronic venous diseases (CVD) is the most common lower extremity vascular pathology. Various vein-specific symptoms and syndromes associated with CVD negatively affect all components of the quality of life in the modern society. The appearance and development of vein-specific symptoms have been proven to be associated with C-nociceptor irritation evoked by the so-called algogens – biologically active substances occurred due to vascular inflammation and endothelial dysfunction along with local temperature elevation and intravenous pressure. Endothelial dysfunction in CVD is mainly due to phlebostasis with a decrease in shear stress, leading to hypoxia of endothelial cells. Further, a multi-stage mechanism of leukocyte-endothelial interaction is activated, which results in the development of venous microangiopathy at the microcirculatory level, as well as the valve apparatus injury and varicose transformation of the principal superficial veins at the macrocirculatory level. It is evident that suppression of the leukocyte-endothelial inflammatory reaction not only leads to a reduction or relief of vein-specific symptoms, but also prevents macro- and microcirculatory disorders. In this regard, the so-called phlebotropic, or venoactive, pharmacological drugs targeting different pathogenetic mechanisms of development and progression of CVD present great interest. In this case, despite the common to this group of drugs phleboprotective effect, the specific mechanisms for achieving it may have significant differences in various venoactive agents. In this review, we discuss the main indications and instructions for the use of phlebotropic drugs in patients with CVD, drawing on the most established international and Russian clinical guidelines.