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1 . 2026

Sulodexide and micronized purified flavonoid fraction in the pharmacotherapy of varicose vein disease: a focus on vein-specific inflammation

Abstract

Background. Varicose vein disease of the lower extremities is a common vascular disorder associated with endothelial dysfunction, chronic inflammation, and venous wall remodeling. A promising therapeutic approach is pharmacotherapy aimed at modulating vein-specific biomarkers, including E-selectin, MCP- 1, VEGF, MMP-2, and MMP-9.

Objective. To evaluate the effects of micronized purified flavonoid fraction (MPFF), sulodexide, and their combination on key biomarker levels and quality of life in patients with VVDLE, depending on the clinical stage (C2–C6).

Material and methods. This prospective comparative study included 198 patients (68.2% female; mean age 43.0±8.72 years; BMI 22.0±2.9 kg/m²), allocated into four groups: compression therapy, MPFF 1000 mg/day, sulodexide 250 LSU twice daily, and MPFF plus sulodexide. Treatment duration was 2 months, with a follow-up period of 12 months. Biomarkers were assessed using the enzyme-linked immunosorbent assay method at visits V0, V2, and V3; quality of life was evaluated using the CIVIQ-20 and SF-36 questionnaires.

Results. In C2–C3 patients, MPFF showed the greatest efficacy, with sustained reductions in E-selectin (−25.4%), MCP-1 (-24.5%), and VEGF (-20.8%) (p<0.001), accompanied by quality-of-life improvement. In C4–C6, sulodexide achieved pronounced and prolonged MMP-9 reduction (-53.8% at 2 months; -24.9% at 12 months) and quality-of-life enhancement. The combination therapy in C4–C6 patients reduced all biomarkers by month 1 and maintained decreases in MMP-2 (-18.2%) and MMP-9 (-24.3%) at 12 months, with persistent CIVIQ-20 and SF-36 improvement. In C2–C3, combination therapy provided no additional benefit and was associated with a higher adverse event rate (28%).

Conclusion. Pharmacotherapy efficacy depends on the stage of VVDLE: MPFF is optimal at early stages, while sulodexide or its combination with MPFF is preferable for advanced disease. A personalized treatment approach enables maximal clinical and biochemical benefits with a comparable safety profile.

Keywords: varicose vein disease; pharmacotherapy; micronized purified flavonoid fraction; sulodexide; vein-specific biomarkers

Funding. The study had no financial support.

Conflict of interest. The authors declare no conflicts of interest.

Authors’ contribution. Study conception and design – Kalinin R.E., Suchkov I.A.; data collection and handling – Kamaev A.A. Suchkov I.A.; draft manuscript preparation – Kamaev A.A.; manuscript revision – Kalinin R.E., Suchkov I.A, Pshennikov A.S.

For citation: Kamaev A.A., Kalinin R.E., Pshennikov A.S., Suchkov I.A. Sulodexide and micronized purified flavonoid fraction in the pharmacotherapy of varicose vein disease: a focus on vein-specific inflammation. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2026; 32 (1): 92–103. DOI: https://doi.org/10.33029/1027-6661-2026-32-1-92-103

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CHIEF EDITOR
CHIEF EDITOR
Yuri V. Belov
Academician of the Russian Academy of Sciences Doctor of Medical Sciences, Professor, President of the Russian Society of Angiologists and Vascular Surgeons

 

In accordance with the decision of the Presidium of the Russian Society of Angiologists and Vascular Surgeons, the journal "Angiology and Vascular Surgery" will be named after Academician A.V. Pokrovsky starting from No. 2/2022.

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