The efficacy of O-(beta-hydroxyethyl)-rutosides (HR) in chronic venous insufficiency (CVI) was assessed by using a meta-analysis on the basis of randomized trials. Analyzed parameters were clinical symptoms related to CVI, i.e. pain of the legs, nocturnal cramps, tired legs, swelling sensations and restless legs. The treatments had to be administered for at least 4 weeks and the average HR dose chosen was 1000 mg/day. On a total of 21 evaluated trials, 15 were selected that included 1973 patients. The placebo-treated group showed a significant (p < 0.01) improvement of patients (i.e., disappearance of the symptoms) as follows: pain 27%, cramps 26%, tired legs 22%, swelling 35% and restless legs 26%. Compared to placebo, the mean additional improvement in favour of HR was 11% for pains, 12% for cramps, 12% for restless legs, 14% for swelling and 24% for tired legs. All these improvements were significant (p < 0.01). The results were robust and stood up to the treatment effect to all meta-analyses across subgroups of randomized clinical trials. In conclusion, this meta-analysis shows that, despite the high response rate to placebo therapy, the effect of HR therapy is significantly superior in the treatment of symptoms related to CVI.