Treatment of chronic venous insufficiency with macerates

Author of the study:
Dr. Lidia Cristaldi
Medical Surgeon Spec. In Angiology, Hygiene and Occupational Medicine.


Chronic venous insufficiency is due to a state of prolonged venous hypertension in the skin and subcutaneous tissue, predominantly in the lower limbs (1).
Under normal conditions, bicuspid venous valves are deputed to direct blood from the superficial veins of the lower extremities to the heart (through the deep venous system), from the bottom to the top against the force of gravity. In IVC (Chronic Venous Insufficiency), these valves are unable to perform this task, so there is reflux (reversal of flow) of blood from the deep to the superficial venous system; therefore, superficial venous hypertension is created.
The consequence is a stagnation of blood within the veins of the lower limbs, which creates continuous pressure on the walls of the veins that can lead, in an advanced stage of the disease, to the exhaustion and dilatation of the wall itself (varices) and the leakage of fluid into the surrounding tissues (edema), producing damage to the organ “Endothelium.”

Role of the endothelium

The Endothelium constitutes the structure that interposes between the vessels and the blood and in addition to regulating barrier function provides the structural and functional basis for phenomena related to homeostasis, thrombosis, and atherogenesis. In capillaries it is the main constituent. Veins originate from the capillary network of various tissues and organs that flow into trunks of increasing caliber. The venous wall differs from the arterial wall mainly in having fewer elastic fibers and more collagen. The anatomical location of the endothelium is strategic, as by interfacing between blood and tissue it plays a key role in maintaining blood fluidity and modulating the activation of coagulation or fibrinolysis. Another not insignificant property is the area it covers, which amounts to several hundred square meters. IVC can be divided into:

  • ORGANIC IVC, which is caused by true pathologies of the veins (varices, venous dithrombosis outcomes, etc.).
  • FUNCTIONAL IVC, which is an expression of a functional overload of veins that, although normal, are called upon to overwork (sural pump insufficiencya change in posture, lymphedema, etc.).

Epidemiology and risk factors

The prevalence of Chronic Venous Insufficiency is 10-15% in the adult male population and 50-55% in the female population.
The disorder predominantly affects the female sex up to the age of 50-60 years, after this age no significant differences are noted between the two sexes.
It is more common in individuals of white race than in those of Asian race.
It is the result of a genetic predisposition associated with various environmental and social factors that lead to or accentuate a state of venous hypertension (pregnancies, constipation, use of oral contraceptives, improper footwear, inadequate clothing, sedentary lifestyle, obesity, alcohol, cigarette smoking, which has a vasoconstrictive action on the arteries, especially the smaller ones), orthopedic abnormalities (flat or hollow feet, postural alterations of the back or knees).
It is gradually increasing in highly urbanized and heavily industrialized populations.
IVC is a disease with a chronic progressive course, which in addition to its undoubted cosmetic implications should be considered as a real social phenomenon, leading to increasing costs for health care facilities.

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