Perforator vein

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Perforator vein
Insufficiency caused by incompetent perforator valve
Details
Identifiers
Latinvenae perforantes
TA23908
Anatomical terminology

Perforator veins are so called because they perforate the deep fascia of muscles, to connect the superficial veins to the deep veins where they drain.[1][2]

Perforator veins play an essential role in maintaining normal blood draining. They have

systole[3]
or contraction.

Location

Diagram showing named veins

Perforator veins exist along the length of the lower limb, in greater number in the leg (anatomical ref to below knee) than in the thigh.

Some veins are named after the physician who first described them:

  • Dodd's perforator at the inferior 1/3 of the thigh
  • Boyd's perforator at the knee level
  • Cockett's perforators at the inferior 2/3 of the leg (usually there are three: superior medium and inferior Cockett perforators)

Others have the name of the deep vein where they drain:

  • Medial gastrocnemius perforator, draining into the gastrocnemius vein
  • Fibular perforators, usually two, one superior near the lateral aspect of the knee and one inferior at the lateral aspect of the ankle

When the valves of perforator veins become incompetent they can cause venous reflux when the muscles contract. This has been explained by Mark Whiteley as "active venous reflux".[4] The resulting reflux can cause a rapid deterioration in an existing varicose disease and be responsible for the development of venous ulcers.

In the past, when varicose vein surgery is undertaken, the surgeon carefully ligated all perforators,

lower limbs venous ultrasonography
plays an important role in evaluating which continent perforators can be used.

However, increasing evidence (see below) is starting to favor the treatment of incompetent perforator veins by minimally invasive techniques such as TRansLuminal Occlusion of Perforators (TRLOP).

Clinical significance

Whether incompetent perforator veins (IPVs) require treatment or not is controversial, particularly when associated with the treatment of varicose veins.[7] However research has shown that there is a clear association between the presence of IPVs and recurrent varicose veins.[8]

Before 1985, the ligation of IPVs needed open surgery. In 1985, G. Hauer described the Sub-fascial endoscopic perforator vein surgery (SEPS) technique[9] allowing IPVs to be clipped through a small incision.

SEPS was superseded in 2001 by minimally invasive laparoscopy, a technique using very small incisions, called TRansLuminal Occlusion of Perforators (TRLOP)[10] which by 2009 had shown to be as effective as SEPS in a 5-year study.[11] As TRLOP can be performed under local anaesthetic and under ultrasound guidance,[12] the advantages over the more invasive and painful SEPS were clear.

In 2007 there was an attempt to rename TRLOP as PAPs (percutaneous ablation of perforators)[13] but PAPs was seen to be merely a copy of the already described TRLOP procedure.[14]

See also

References

  1. PMID 9240321
    .
  2. ^ http://www.veinsveinsveins.com/perforators[full citation needed]
  3. PMID 16230038
    .
  4. ^ "Understanding Venous Reflux - the cause of varicose veins and venous leg ulcers". 2011. Archived from the original on 2017-10-25. Retrieved 2015-02-02.
  5. PMID 17857163
    .
  6. ISBN 2-906594-06-7.[page needed
    ]
  7. PMID 25132056
    .
  8. PMID 11352523
    .
  9. PMID 3976278
    .
  10. doi:10.1046/j.0007-1323.2001.02021.x
    .
  11. S2CID 3234094
    .
  12. ^ The College of Phlebology (December 14, 2012). "TRLOP closure of incompetent perforating vein (IPV)". The College of Phlebology. Retrieved August 25, 2014.
  13. S2CID 10251336
    .
  14. S2CID 19494455
    .
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