By: Nicos Labropoulos, PhD, RVT
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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
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).
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.
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