Early chronic venous disease may significantly impair quality of life even in the absence of overt varicose disease, and effective conservative strategies are needed to relieve symptoms and possibly slow disease progression. This prospective observational pilot study evaluated the effectiveness and tolerability of a nutraceutical fixed combination with venotropic, anti-inflammatory and draining activity in adults with symptoms suggestive of early-stage chronic venous disease (CEAP C0s-C1s). Sixty patients aged 35-70 years were enrolled, and 40 completed the 90-day follow-up; the 33.3% drop-out/non-completer rate is explicitly reported as a major real-world limitation. Participants received one tablet daily containing micronized flavonoids (μsMIN® Plus; 570 mg, including diosmin 450 mg), Boswellia serrata (Bospure®), bromelain (Bromeyal®), hesperidin, Melilotus officinalis, pineapple extract, and vitamin C. The primary endpoint was the change in ankle circumference from baseline to day 90. Secondary endpoints included patient-reported symptoms assessed by visual analogue scales for pain, heaviness/warmth, itching, nocturnal cramps, self-perceived edema/swelling, visible varicosity, and self-perceived quality of life. Of the 60 enrolled patients, 40 completed the study, corresponding to a 33.3% drop-out/non-completer rate (20/60). Eight patients were lost to follow-up and 12 did not consistently take the tested product (adherence <70%). This high drop-out rate substantially limits the statistical analysis and the value of the final outcomes. In the completer population, mean ankle circumference significantly decreased from 23.1±1.8 cm at baseline to 21.4±1.4 cm at Day 90, corresponding to a mean reduction of 1.7±0.5 cm (p=0.023). Significant improvements were also observed in all subjective parameters except visible varicosity, with benefits already detectable at Day 45 and maintained or enhanced at Day 90. No adverse events leading to treatment discontinuation were reported. In this real-world cohort of patients with symptoms suggestive of early chronic venous disease, the tested nutraceutical combination was associated with significant improvements in both objective and subjective outcomes and was well tolerated. However, given the uncontrolled observational design and the 33.3% drop-out/non-completer rate, these findings should be considered preliminary and not definitive evidence of a causal treatment effect.
Growing evidence suggests that, in selected varicose vein patients, isolated tributary treatment (by phlebectomy, sclerotherapy, laser or disconnection) may avoid the sacrifice of the great saphenous vein, thereby simplifying varicose vein management and preserving saphenous capital. Patient selection relies primarily on detailed ultrasound assessment of venous haemodynamic, with particular attention to the Sapheno-Femoral Junction (SFJ), and re-entry perforators evaluated using the Reflux Elimination Test (RET). A structured checklist to predict surgical success may assist surgeons and support shared decision-making with patients by integrating anatomical, hemodynamic, clinical, and technical factors.
Lymphedema affects approximately 10 million Americans, with obesity identified as one of its strongest modifiable risk factors. Despite well-established links between dietary patterns, obesity, and lymphatic dysfunction, no standardized nutrition screening tool has been validated for use in lymphedema practice. This cross-sectional survey examined Certified Lymphedema Therapists’ (CLTs) perceptions of Picture Your Plate™ (PYP™) as a dietary screening instrument. Findings reveal a field-wide gap in the standardization of nutrition screening and support the need for validated referral protocols and dietary assessment education in lymphedema certification pathways. As these findings are based on clinician perceptions rather than clinical outcomes or real-world practice patterns, they should be interpreted as exploratory. The 12.4% response rate introduces the possibility of selection bias, as respondents may disproportionately represent clinicians with heightened interest in nutrition, which could limit the generalizability of these findings to the broader CLT population.
Venous ulcers are the most common ulcerative lesions of the lower limbs and represent a major clinical challenge, particularly in the geriatric population. Chronic cutaneous ulcers are frequently associated with cardiovascular and metabolic comorbidities, which impair tissue repair and prolong healing. Pain is the predominant symptom, resulting from exposure of deeper epithelial layers to inflammatory and irritative processes. Diagnosis relies on clinical evaluation, venous colour Doppler ultrasonography, and laboratory investigations. Treatment is guided by ulcer aetiology and includes compression therapy, advanced wound dressings, surgical debridement, negative pressure wound therapy, and dermal substitutes. Because the extracellular matrix plays a dynamic role in tissue regeneration, therapeutic strategies emphasise wound bed preparation and acellular dermal matrices. These biomaterials provide a non-immunogenic scaffold that supports cell migration while avoiding donor-site morbidity. In a retrospective observational study of 62 patients with chronic cutaneous ulcers, predominantly venous, an integrated therapeutic approach combining surgery, selective debridement, and regenerative biomaterials resulted in clinical improvement in 71.29% of patients. Dermal substitutes were associated with a marked reduction in postoperative pain, with NRS scores decreasing from 6-7 to 0-3 overall.
