Effects of neuromuscular electrical stimulation on symptoms of chronic venous disease of the lower limbs: a systematic review

Introduction: Chronic venous disease (CVD) is highly prevalent, imposing a significant burden on patients. Treatment options include surgical and nonsurgical modalities. Neuromuscular electrical stimulation (NMES) is an alternative that artificially activates the calf muscle pump, improving blood flow parameters. This systematic review evaluates its effectiveness in relieving CVD symptoms. Methods: PubMed, Web of Science, and Scopus were sought for experimental and observational studies published between 2000 and March 2025. Included studies assessed NMES for CVD symptoms. Exclusion criteria were electrode application directly to or around ulcers and sample sizes under 10 patients. The primary objective included peripheral edema, quality of life, venous leg ulcer healing, and leg pain. Adverse effects were the secondary outcome. Risk of bias was evaluated using appropriate tools. Results: Out of 269 records gathered, eight were included (three randomized controlled trials, one nonrandomized controlled trial, and four case series), totaling 311 patients, 214 of whom used NMES. The mean age was 56.7 years (95% CI: 48.0–65.4 years) and 49.9% (95% CI 40.5–59.2%) were women. Devices used were Geko and Veinoplus (three studies each) and Revitive IX (two studies). Six studies evaluated edema, with a decrease in NMES groups in four. Quality of life was evaluated in five studies; pain and ulcer healing were appraised in three each, all showing improvement. Reported adverse effects included mild skin irritation and rash. Conclusion: NMES shows promising results across all outcomes studied. However, studies may suffer from publication or selection bias, imperfect designs, and other individual factors. (PROSPERO registration No.: CRD42023401762)