Although venous stasis due to blood stagnation in lower limbs has been recognised as an important etiological factor for the development of varicose veins, the mechanism linking this ischemic situation to the modifications of the venous wall in varicose veins is still unclear. There is evidence that the activation of the endothelium during blood stasis and its subsequent cascade of interactions with other cell types could alter the structure of the vein wall and could possibly be at the origin of the disease. While phlebotonic drugs are often used to improve symptoms in chronic venous insufficiency, their precise mechanism of action is not well understood. We now tested aescine (Reparil i.v. form) in an ex vivo model which mimics this situation, i.e., perfused human umbilical vein exposed to hypoxic conditions. To study the effect of aescine on neutrophil activation and adhesion to the endothelium, human umbilical veins were incubated under hypoxic conditions with or without aescine and the interactions between the endothelium and neutrophil-like cells, HL60, were investigated. We observed that a large number of HL60 became adherent to the endothelium of veins after 2 h hypoxia and that these adherent HL60 were activated: they released high amounts of superoxide anion and of leukotriene B4. Aescine (250 ng/ml or 0.22 microM) was shown to markedly inhibit HL60 adherence to hypoxic endothelium. By decreasing the number of adherent HL60, aescine also decreased the subsequent production of superoxide anion and of leukotriene B4. Scanning electron microscopy confirmed the increased HL60 adherence to the endothelium, as well as the inhibitory effect of aescine. These results support results of in vitro studies on isolated endothelial cells in which aescine was shown to inhibit the hypoxia-induced activation of endothelial cells and the subsequent increased adherence of neutrophils. In vivo, the activated and infiltrated leukocytes release free radicals, chemotactic molecules such as leukotriene B4 and proteases which then can degrade the extracellular matrix. These processes could contribute to alterations of the venous wall similar to those observed in varicose veins. By maintaining an intact endothelium during in vivo blood stasis in the lower limbs and preventing neutrophil recruitment, adherence and activation, aescine could prevent the resulting alterations of the venous wall. These results could explain at least in part the potential benefit of the drug in the prevention of venous insufficiency.