Chronic venous insufficiency (CVI) is a common condition with high impact on the healthcare system [
1]. An epidemiological survey of 6009 patients, conducted in Belgium and Luxembourg, evidenced a high prevalence of CVI (61.3%) [
2]. Prevalence will increase due to its main risk factors, including age, family history, obesity and necessity to stand at work [
3]. For example, in a study including 541 Japanese women, 42% of subjects with varicose veins reported a positive family history compared with just 14% of women without disease; this difference is reduced with increasing age [
4]. In the USA, the number of venous thromboembolism cases has been projected to increase from 1 million in 2010 to 1.8 million in 2050 [
5], while varicose vein procedures are projected to increase by over 60% in the USA and Europe between 2013 and 2021 [
6]. The CVI diagnosis is confirmed and classified with the Clinical, Etiologic, Anatomical, and Pathophysiological (CEAP) assessment (range: C0–C6) [
7]. The CEAP classification for chronic venous disorders was developed in 1994 by an international ad hoc committee of the American Venous Forum, endorsed by the Society for Vascular Surgery, and incorporated into “Reporting Standards in Venous Disease” in 1995 [
8]. Chemical endocavitary thermal treatments are a standard therapy due to low invasiveness, good efficacy and low complication rate [
9]. Furthermore, they allow the patient to return to daily activities in a short time-frame post-treatment since CVI is cause of discomfort, pain, loss of working days, disability and reduction in quality of life [
10‐
12]. The sclerofoam-assisted laser treatment (SFALT) technique
13 is routinely used in Italy and combines intravenous sclerofoam injection (polidocanol 3% or sodium tetradecyl sulphate 3% according to Tessari’s method) followed by endothelium stripping with fibre optic (600µ)–coupled laser diode (1470 nm wavelength) delivered at 40 J/cm fluence [
14,
15]. This instrumental treatment can be combined to pharmacological or nutraceutical therapy to reduce pain, edema, inflammation and fluid retention (common side effects of traditional varicose vein treatments) and to induce rapid functional restoration in CVI patients [
16]. Other add-on therapies can include (1) leg elevation [
1,
17], (2) pharmacological therapy using vasoactive drugs that include coumarins, flavonoids, saponosides and other plant extracts, whose action is to improve venous tone and capillary permeability [
1,
17] and (3) exercise therapy to improve calf muscle function [
18]. The emergent role of herbal therapy administered orally or topically to patients has also been highlighted [
19‐
21]. The advantage of herbal formulations is that multiple active principles are administered to the patient simultaneously, allowing synergistic action [
22]. For this reason, the nutraceutical market in phlebology has sharply increased in the last 10 years [
23]. Hence, in the current study, we evaluated the efficacy of SFALT combined with formulated compounds that display specific effects on the microcirculation of the operated leg.