Grape Leaves — Do Grapes Treat Varicose Veins Better Than Pills?

Aim of the study: Chronic venous insufficiency (CVI) is common in adults. Some complications include skin changes, edema, heavy legs, muscle cramps, pain, and varicose veins. In traditional medicine, red vine leaf extract (AS 195) has been used to cure the symptoms of CVI. This systematic review was aimed to assess the effects of AS 195 in patients with CVI.

Results: Of the 56 studies, 5 trials were selected according to our inclusion criteria. Red vine leaf extract significantly improved a number of outcomes (lower leg volume, calf and ankle circumference, tired and heavy legs, tingling sensation, pain, the sensation of tension in the legs, cutaneous microcirculation, and transcutaneous oxygen pressure) in only some trials. The tolerability of red vine leaf extract was reported to be good or satisfactory. Red vine leaf extract had a beneficial therapeutic role in patients with CVI. Further high-quality trials are needed to provide strong evidence.

Aim of the study: The aim of this study was to investigate the effect of a red-vine-leaf extract (AS195, Antistax(®), Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany) on the volume of the leg and clinical symptoms in patients with chronic venous insufficiency (CVI).

Results: The full-analysis set included 248 patients (placebo: n = 122; AS195: n = 126). After 12 weeks, AS195 significantly reduced lower limb volume by a mean of 19.9 standard error (SE) 8.9 ml over placebo (95% confidence interval (CI): -37.5, -2.3; p = 0.0268; analysis of covariance, ANCOVA). The standardised effect size of 0.28 for volume reduction indicates a clinically relevant effect. On Day 84, the symptom of 'pain in the legs' assessed by visual analogue scale decreased in the AS195 group compared with the placebo group: mean difference -6.6 SD 3.3 mm (95% CI: -13.1,-0.1; p = 0.047). Other symptoms showed no significant change. The tolerability of AS195 was similar to that of placebo. AS195 treatment for 84 days resulted in an approximately 20 ml reduction of limb volume in the active treatment group compared with the placebo group. Patients reported subjective improvement following treatment with AS195 compared with placebo.

Aim of the study: To investigate the effect of the red vine leaf extract AS 195 on cutaneous microvascular blood flow, transcutaneous oxygen pressure (tcpO2), and leg oedema in patients with chronic venous insufficiency (CVI).

Results: After 6 weeks, patients in the AS 195 group had increased microvascular blood flow values (+241.8 +/- 18.7 arbitrary units [AU] versus a decrease of -41.0 +/- 18.7AU in the placebo group; p < 0.0001). Oxygen increased to 1.35 +/- 0.97mm Hg (placebo: decrease of -7.27 +/- 0.97mm Hg; p < 0.0001). After 6 weeks of treatment the leg circumference was decreased (ankle level: by -0.39 +/- 0.09cm versus +0.29 +/- 0.09cm; p < 0.0001; calf level: by -0.54 +/- 0.05cm versus +0.14 +/- 0.05cm; p < 0.0001). The administration of AS 195 improved objective symptoms of CVI and may prevent CVI deterioration.

Aim of the study: The characteristic components of the pure plant-based extract AS 195 (Folia vitis viniferae) are flavon(ol)-glycosides and glucuronides with quercetin-3-O-beta-D-glucuronide (main flavonoid) and isoquercitrin (quercetin-3-O-beta-glycoside; a secondary flavonoid).

Results: Six patients experienced adverse events potentially causally related to trial medication. Four of them reported gastrointestinal problems. The present study showed a marked improvement of subjective symptoms associated with CVI grade I or II, as well as a good or satisfactory global assessment of efficacy and tolerability by the patients and the investigators. Thus, AS 195 film-coated tablets can be considered as effective and safe in patients with CVI grade I or II.

Aim of the study: An open, observational clinical study to investigate the onset of action of the extract of the red vine-leaf AS 195 has been conducted in 39 patients suffering from Chronic Venous Insufficiency [CVI; grade I or II according to the Widmer classification (grade 2 to 4 of the international CEAP classification)]. Symptoms of CVI in the patients included oedema and subjective clinical complaints.

Results: The measured intensity on the VAS decreased on the average by 2.2 points after 2 weeks (t=-8.21 p<0.001), 2.6 points after 4 weeks (t=-10.93 p<0.001) and 2.6 points after 6 weeks (t=-10.75 p<0.001). In general, the treatments were well tolerated. Three patients prematurely stopped the trial for reasons not linked to the treatment or to the disease. This study has shown a fast onset of action and an excellent efficacy of the vitis viniferae Folia AS 195 extract in Chronic Venous Insufficiency.

Aim of the study: This paper continues our review of scientifically evaluated plant extracts in dermatology. After plants effective against dermatophytes, botanicals with anti-edema effects in chronic venous insufficiency are discussed.

Results: There is good evidence from randomized clinical studies that plant extracts from grape vine leaves (Vitis vinifera), horse chestnut (Aesculus hippocastanum), sea pine (Pinus maritima) and butcher's broom (Ruscus aculeatus) can reduce edema in chronic venous insufficiency. Plant extracts from witch hazel (Hamamelis virginiana), green tea (Camellia sinensis), the fern Polypodium leucotomos and others contain antioxidant polyphenolic compounds that may protect the skin from sunburn and photoaging when administered topically or systemically. Extracts from the garden spurge (Euphorbia peplus) and from birch bark (Betula alba) have been shown to be effective in the treatment of actinic keratoses in phase II studies. Some plant extracts have also been investigated in the treatment of vitiligo, various forms of hair loss and pigmentation disorders, and in aesthetic dermatology.