Perforator vein | |
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Details | |
Identifiers | |
Latin | venae perforantes |
TA2 | 3908 |
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 valves which prevent blood flowing back (regurgitation) from deep to superficial veins in muscular systole [3] or contraction.
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:
Others have the name of the deep vein where they drain:
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, [5] but some believe that you can use conservative techniques to treat varicose disease use perforators to drain the superficial venous system. [6] In this case, 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).
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SEPS was superseded in 2001 by minimally invasive laparoscopy, a technique using very small incisions, called TRansLuminal Occlusion of Perforators (TRLOP) [10] which by 2009 had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]
Varicose veins, also known as varicoses, are a medical condition in which superficial veins become enlarged and twisted. These veins typically develop in the legs, just under the skin. Varicose veins usually cause few symptoms. However, some individuals may experience fatigue or pain in the area. Complications can include bleeding or superficial thrombophlebitis. Varices in the scrotum are known as a varicocele, while those around the anus are known as hemorrhoids. Due to the various physical, social, and psychological effects of varicose veins, they can negatively affect one's quality of life.
Veins are blood vessels in the circulatory system of humans and most other animals that carry blood towards the heart. Most veins carry deoxygenated blood from the tissues back to the heart; exceptions are those of the pulmonary and fetal circulations which carry oxygenated blood to the heart. In the systemic circulation, arteries carry oxygenated blood away from the heart, and veins return deoxygenated blood to the heart, in the deep veins.
Vascular surgery is a surgical subspecialty in which vascular diseases involving the arteries, veins, or lymphatic vessels, are managed by medical therapy, minimally-invasive catheter procedures and surgical reconstruction. The specialty evolved from general and cardiovascular surgery where it refined the management of just the vessels, no longer treating the heart or other organs. Modern vascular surgery includes open surgery techniques, endovascular techniques and medical management of vascular diseases - unlike the parent specialities. The vascular surgeon is trained in the diagnosis and management of diseases affecting all parts of the vascular system excluding the coronaries and intracranial vasculature. Vascular surgeons also are called to assist other physicians to carry out surgery near vessels, or to salvage vascular injuries that include hemorrhage control, dissection, occlusion or simply for safe exposure of vascular structures.
Stephanie Jayne "Steph" Cook, MBE is a British retired modern pentathlete. She was the Olympic champion at this event in 2000.
Telangiectasias, from Greek: tel- (end) + angi- + ectasia, also known as spider veins, are small dilated blood vessels that can occur near the surface of the skin or mucous membranes, measuring between 0.5 and 1 millimeter in diameter. These dilated blood vessels can develop anywhere on the body, but are commonly seen on the face around the nose, cheeks and chin. Dilated blood vessels can also develop on the legs, although when they occur on the legs, they often have underlying venous reflux or "hidden varicose veins". When found on the legs, they are found specifically on the upper thigh, below the knee joint and around the ankles.
Endovenous laser treatment (ELT) is a minimally invasive ultrasound-guided technique used for treating varicose veins using laser energy commonly performed by a phlebologist, interventional radiologist or vascular surgeon.
Sclerotherapy is a procedure used to treat blood vessel malformations and also malformations of the lymphatic system. A medication is injected into the vessels, which makes them shrink. It is used for children and young adults with vascular or lymphatic malformations. In adults, sclerotherapy is often used to treat spider veins, smaller varicose veins, hemorrhoids, and hydroceles.
The small saphenous vein is a relatively large superficial vein of the posterior leg.
The posterior tibial veins are veins of the leg in humans. They drain the posterior compartment of the leg and the plantar surface of the foot to the popliteal vein.
Venous ulcer is defined by the American Venous Forum as "a full-thickness defect of skin, most frequently in the ankle region, that fails to heal spontaneously and is sustained by chronic venous disease, based on venous duplex ultrasound testing." Venous ulcers are wounds that are thought to occur due to improper functioning of venous valves, usually of the legs. They are an important cause of chronic wounds, affecting 1% of the population. Venous ulcers develop mostly along the medial distal leg, and can be painful with negative effects on quality of life.
Compression stockings are a specialized hosiery designed to help prevent the occurrence of, and guard against further progression of, venous disorders such as edema, phlebitis and thrombosis. Compression stockings are elastic compression garments worn around the leg, compressing the limb. This reduces the diameter of distended veins and increases venous blood flow velocity and valve effectiveness. Compression therapy helps decrease venous pressure, prevents venous stasis and impairments of venous walls, and relieves heavy and aching legs.
Chronic venous insufficiency (CVI) is a medical condition in which blood pools in the veins, straining the walls of the vein. The most common cause of CVI is superficial venous reflux which is a treatable condition. As functional venous valves are required to provide for efficient blood return from the lower extremities, this condition typically affects the legs. If the impaired vein function causes significant symptoms, such as swelling and ulcer formation, it is referred to as chronic venous disease. It is sometimes called chronic peripheral venous insufficiency and should not be confused with post-thrombotic syndrome in which the deep veins have been damaged by previous deep vein thrombosis.
Paolo Zamboni is an Italian doctor and scientist. He is full Professor and Director of the School of Vascular Surgery at the University of Ferrara in Italy.
Pelvic congestion syndrome, also known as pelvic vein incompetence, is a long-term condition believed to be due to enlarged veins in the lower abdomen. The condition may cause chronic pain, such as a constant dull ache, which can be worsened by standing or sex. Pain in the legs or lower back may also occur.
Communicating veins are veins that communicate two different points of the same venous system. Other veins that connect the superficial venous system with the deep venous system are known as perforator veins.
Ultrasonography of suspected or previously confirmed chronic venous insufficiency of leg veins is a risk-free, non-invasive procedure. It gives information about the anatomy, physiology and pathology of mainly superficial veins. As with heart ultrasound (echocardiography) studies, venous ultrasonography requires an understanding of hemodynamics in order to give useful examination reports. In chronic venous insufficiency, sonographic examination is of most benefit; in confirming varicose disease, making an assessment of the hemodynamics, and charting the progression of the disease and its response to treatment. It has become the reference standard for examining the condition and hemodynamics of the lower limb veins. Particular veins of the deep venous system (DVS), and the superficial venous system (SVS) are looked at. The great saphenous vein (GSV), and the small saphenous vein (SSV) are superficial veins which drain into respectively, the common femoral vein and the popliteal vein. These veins are deep veins. Perforator veins drain superficial veins into the deep veins. Three anatomic compartments are described, (N1) containing the deep veins, (N2) containing the perforator veins, and (N3) containing the superficial veins, known as the saphenous compartment. This compartmentalisation makes it easier for the examiner to systematize and map. The GSV can be located in the saphenous compartment where together with the Giacomini vein and the accessory saphenous vein (ASV) an image resembling an eye, known as the 'eye sign' can be seen. The ASV which is often responsible for varicose veins, can be located at the 'alignment sign', where it is seen to align with the femoral vessels.
The Giacomini vein, or cranial extension of the small saphenous vein is a communicating vein between the great saphenous vein (GSV) and the small saphenous vein (SSV). It is named after the Italian anatomist Carlo Giacomini (1840–1898). The Giacomini vein courses the posterior thigh as either a trunk projection, or tributary of the SSV. In one study it was found in over two-thirds of limbs. Another study in India found the vein to be present in 92% of those examined. It is located under the superficial fascia and its insufficiency seemed of little importance in the majority of patients with varicose disease, but the use of ultrasonography has highlighted a new significance of this vein. It can be part of a draining variant of the SSV which continues on to reach the GSV at the proximal third of the thigh instead of draining into the popliteal vein. The direction of its flow is usually anterograde but it can be retrograde when this vein acts as a bypass from an insufficient GSV to SSV to call on this last one to collaborate in draining. Many discussions exist about this vein, some of them confusing to a non-expert reader. Insufficiency in the Giacomini vein can present in isolation but is mostly seen together with a GSV insufficiency. It has been shown to be effectively treated either with endovenous laser ablation or by ultrasound guided sclerotherapy.
Claude Franceschi is an angiologist French MD.
Ultrasonography in suspected deep vein thrombosis focuses primarily on the femoral vein and the popliteal vein, because thrombi in these veins are associated with the greatest risk of harmful pulmonary embolism.
CHIVA method is a type of surgery used to treat varicose veins that occur as a result of long term venous insufficiency. The term is a French acronym for Conservatrice Hémodynamique de l'Insuffisance Veineuse en Ambulatoire.