Thigh, Calf & Ankle Perforators: Are They Different?
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By: Nicos Labropoulos, PhD, RVT Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
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Thigh, Calf & Ankle Perforators: Are They Different?
- 1. Disclosure Nicos Labropoulos, PhD, RVT I disclose the following financial relationship(s): •Speaker/Honoraria: Cook •Consultant/Advisory Board: Cook, Covidien
- 2. Thigh, Calf & Ankle Perforators: Are They Different? Nicos Labropoulos Professor of Surgery and Radiology Director, Vascular Laboratory Division of Vascular Surgery Stony Brook University Medical Center Stony Brook, New York, USA
- 3. Limborgh J van. Folia Angiol 1961;8: 240-57 About 150 perforator veins About 30 perforator veins most commonly incompetent Labropoulos N, et al. EJVES 1999;18:228-34
- 4. Labropoulos N, et al. EJVES 1999;18:228-34 More muscle mass longer distance longer veins Higher number More often duplicated axial vein muscular vein
- 5. Ascending reflux Re-entry veins that eventually become incompetent Descending process Labropoulos N, et al. J Vasc Surg 2006;43:558-62
- 6. More often associated with skin damage Labropoulos N, et al. J Vasc Surg 1995;22:45-50 Labropoulos N, et al. J Vasc Surg 2006;43:558-62 Labropoulos N, et al. Vasc Endovascular Surg 2007; 41; 33
- 9. Inward and outward flow Outward flow Inward flow
- 11. Labropoulos N et al. EJVES 1999;18:228-34
- 14. Lower calf posterolateral PV
- 15. Labropoulos N, et al. J Vasc Surg 2003;38:793-8 Reflux cut-off values Superficial veins >500ms Perforator veins >350ms Calf veins + Deep femoral >500ms Femoropopliteal veins >1000ms
- 16. Labropoulos N, et al. J Vasc Surg 2006;43:558-62 Perforator vein reflux development 29 limbs in 26 patients with PV reflux development. In total 38 new incompetent PVs were identified. The median time for the examination was 25 months (range 9 to 52).
- 17. Midthigh medial PV reflux
- 18. Reflux in a previously normal PV at a re-entry site was detected in 15. In ascending manner from extension of superficial vein reflux in 18. In a new previously intact location in 5.
- 19. Tributary reflux 27 months later ascending reflux in a perforator vein
- 20. Lower calf medial 44 months later descending reflux
- 21. Midcalf medial 38 months later reflux in a new location
- 22. N R R R R N N Female 53y, 2 pregnancies, FH: +ve, DOD: 14y C1-2A EP AS PR C1-3A EP AS PR First exam R N N NR N
- 23. R R R R R R N N Female 53y, 2 pregnancies, FH: +ve, DOD: 17y R R C1-3A EP AS+P PR C1-4S EP AS+P PR 2nd exam at 38 months R R R N N R Ascending New Descending
- 24. Labropoulos N, et al. J Vasc Surg 1997;26:743-8
- 25. Pathologic perforator? Large diameter with reflux associated with patients signs and symptoms 8.5mm 6.4mm
- 26. Retrograde Resin Venography Venous Insufficiency Clinical class 4-6 Prof. Andre van Rij Chairman Department of Surgery
- 28. Boundary Valves
- 30. C4 and C6, edge of venous ulcer
- 37. SEM Retrograde Resin Venography: Clinical C-4 Skin