Adjunctive citrus flavonoids after endovenous microwave ablation for great saphenous vein varicosis: A retrospective...

To evaluate whether adjunctive citrus flavonoids are associated with improved venous hemodynamics and short-term outcomes after endovenous microwave ablation (EMA) for great saphenous vein varicosis in a retrospective cohort.

This single-center retrospective cohort study included 254 patients with great saphenous vein varicosis treated between January 2022 and July 2025. Patients were grouped according to the actual treatment received: EMA alone (n = 126) or EMA plus micronized purified flavonoid fraction (MPFF; n = 128). In the combination group, MPFF was administered at 1000 mg twice daily (2000 mg/d) for 2 weeks; this was twice the usual approved dose for venolymphatic insufficiency. The primary outcome was overall clinical response at 2 weeks. Secondary outcomes included Venous Clinical Severity Score, Aberdeen Varicose Vein Questionnaire, Chronic Venous Insufficiency Questionnaire, venous hemodynamic parameters, exploratory endothelial biomarkers (such as endothelin-1, nitric oxide, and circulating endothelial cells), treatment-related adverse events, and 6-month ultrasound findings.

Compared with EMA alone, adjunctive MPFF was associated with a higher overall clinical response and greater improvements in Venous Clinical Severity Score, Aberdeen Varicose Vein Questionnaire, and Chronic Venous Insufficiency Questionnaire scores (all P < .05). Mean and peak venous flow velocities improved more in the combination group (P < .05). The combination group also showed lower endothelin-1 and circulating endothelial cell levels and higher nitric oxide levels after treatment (P < .05). Recorded adverse events did not differ significantly between groups (P > .05). At 6 months, the combination group showed a higher rate of complete occlusion and less residual reflux (P < .05).

In this retrospective cohort, adjunctive citrus flavonoids after EMA were associated with better early symptom scores, venous hemodynamic indices, and endothelial biomarker profiles without a detected increase in recorded adverse events. As the study was observational and used a nonstandard MPFF dose, these findings should be interpreted as associations rather than evidence of causality, proof of safety, or support for the 2000 mg/d regimen. Prospective randomized trials using approved dosing are needed to confirm these findings.