[The flow of venous blood in the obese]

The increase of adipose tissue disturbs the cutaneous venous circulation. In the normal subject, this flow, in the subcutaneous space, occurs between two networks joined by drainage veins. The responsible motor forces are multiple (residual arteriolar pressure, negative transmural pressure) (effect of compression). In the obese patient, hypertrophy of the adipose tissue-mass damages the drainage veins and provokes stasis, evolving in two stages: at first the disorders are reversible (venous dilatation); then definitive tissular damage occurs (epidermis, plexus, veins, muscles, fatty masses). This disintegration accounts for the clinical symptoms (oedema, varicose veins, trophic disorders). There are three conclusions to be drawn from this: adiposity will always be accompanied by venous insufficiency; it is dangerous to make a long-overweight patient reduce weight; adiposity must be treated very early on.