Chronic venous insufficiency is a very common and very uncomfortable condition. It occurs when the valves in the veins of the legs become leaky, leading to leg swelling, pain and itching. When severe, skin breakdown can occur. The most effective treatment is compression stockings, which can be uncomfortable and difficult to use. An effective oral medication would be a major advance in terms of convenience.

Horse chestnut seed extract (HCSE) is a herbal remedy sometimes used for venous insufficiency. The current issue of the ACP Journal Club [vol 145, no 1, p 20] reviews a comprehensive analysis of randomized trials in the Cochrane Database of Systematic Reviews comparing HCSE either to placebo or to compression stockings.

Many of the studies found HCSE more effective than placebo. Some found HCSE as effective as compression stockings.

The caveats are that the studies were all short term so the long term safety and efficacy of HCSE remains unknown, and up to a third of patients in some of the trials reported side effects such as dizziness or stomach upset with HCSE. Nevertheless, this provides a hint at a possible treatment for a chronic and frustrating condition.