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. 2018 Jun;50(2):99-104.
doi: 10.5152/eurasianjmed.2018.18338. Epub 2018 Apr 30.

Frequency and Significance of Perforating Venous Insufficiency in Patients with Chronic Venous Insufficiency of Lower Extremity

Ismet Tolu  1 , Mehmet Sedat Durmaz  1
Affiliations

Frequency and Significance of Perforating Venous Insufficiency in Patients with Chronic Venous Insufficiency of Lower Extremity

Ismet Tolu et al. Eurasian J Med. 2018 Jun.

Abstract

Objective: The aim of this study was to reveal the frequency and impact of perforating venous insufficiency (PVI) in chronic venous insufficiency (CVI) of lower extremity (LE).

Materials and methods: Between 2012 and 2017, a total of 1154 patients [781 females (67.68%) and 373 males (32.32%), 228 (19.76%) unilateral and 926 (80.24%) bilateral LE] were examined using Doppler ultrasound (US). A total of 2080 venous systems of LEs [31.4% male (n=653) and 68.6% female (n=1427); 1056 left LEs (50.77%) and 1024 right LEs (49.23%)] were examined. All patients had symptoms of venous insufficiency (VI).

Results: PVI was revealed in 27.5% (n=571) of LEs. Varicose veins (VVs) related with perforating vein (PV) were revealed in 44.7% of LEs (n=929). PVI was observed in 50.91% of patients with chronic deep venous thrombosis (DVT), 64.41% with deep venous insufficiency (DVI), 59.81% with great saphenous vein (GSV) insufficiency, 68.49% with small saphenous vein (SSV) insufficiency, 58.65% with accessory GSV insufficiency, and 58.77% with PV associated with VVs. There was a statistically significant relationship between PVI and chronic DVT, DVI, GSV, SSV, and accessory GSV insufficiency (p<0.001). A significant relationship was observed between the increase in PV diameter and the presence of PVI (p<0.001).

Conclusion: PVI is quite common in combined VI, and PV evaluation should be a part of LE venous system examination.

Keywords: Chronic venous insufficiency; doppler ultrasound; perforating venous insufficiency; varicose veins.

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Conflict of interest statement

Conflict of Interest: Authors have no conflict of interest to declare.

Figures

Figure 1.
Figure 1.
Schematic images of the main groups of PVs in LE
Figure 2. a–d.
Figure 2. a–d.
Sonographic evaluation of PV. PV obliquely perforates the deep muscular fascia and associates the with the superficial vein (a), diameter of PV measured at the suprafascial–subfascial connection level (b), augmentation of blood flow by compression of the limb below PV and Valsalva’s maneuver are used to assess valvular integrity with color flow imaging (c), and spectral Doppler imaging (d)
Figure 3. a–e.
Figure 3. a–e.
Sonographic imaging of perforating vein (PV) associated with varicose vein and saphenous veins. Enlarged posterior tibial (Cockett’s) PV obliquely perforates the deep muscular fascia and connects with the crural varicose vein (a). Power Doppler imaging showing reflux both in the posterior tibial PV and in the varicose vein following a Valsalva’s maneuver (b). Spectral Doppler imaging showing significant reflux in the paratibial (Sherman) PV following a Valsalva’s maneuver (c). Spectral Doppler imaging showing significant reflux in the medial thigh (Hunter’s) PV associated with saphenous vein following compression of the distal parts of the calf (d). Power Doppler imaging showing reflux in the posterior leg (lateral gastrocnemius) PV associated with small saphenous vein following a Valsalva’s maneuver (e)
Figure 4. a–c.
Figure 4. a–c.
Reflux in saphenous veins. Longitudinal view and spectral Doppler imaging show significant reflux in the great saphenous vein at the level of distal thirds of the thigh following a Valsalva’s maneuver (a). Spectral Doppler imaging showing significant reflux in the great saphenous vein at the level of distal thirds of the thigh (b) and in the small saphenous vein distal to the saphenopopliteal junction in the proximal cruris, following compression of the distal parts of the calf (c)
See this image and copyright information in PMC

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