Date post: | 03-Jun-2015 |
Category: |
Health & Medicine |
Upload: | vein-global |
View: | 353 times |
Download: | 1 times |
Disclosure Nicos Labropoulos, PhD, RVT
I disclose the following financial relationship(s):
•Speaker/Honoraria: Cook
•Consultant/Advisory Board: Cook, Covidien
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
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
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
Ascending reflux
Re-entry veins that
eventually become
incompetent
Descending process
Labropoulos N, et al.
J Vasc Surg 2006;43:558-62
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
Midcalf medial duplicated PV
Normal Incompetent
Inward and outward flow
Outward flow
Inward flow
Labropoulos N et al. EJVES 1999;18:228-34
Lower calf posterolateral PV
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
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).
Midthigh medial PV reflux
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.
Tributary reflux 27 months later ascending
reflux in a perforator vein
Lower calf medial 44 months later descending reflux
Midcalf medial 38 months later reflux in a new location
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 N R
N
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
Labropoulos N, et al. J Vasc Surg 1997;26:743-8
Pathologic perforator?
Large diameter with reflux associated with patients
signs and symptoms
8.5mm 6.4mm
Retrograde Resin Venography
Venous Insufficiency
Clinical class 4-6
Prof. Andre van Rij
Chairman
Department of Surgery
Retrograde Resin Venography
Boundary Valves
C4 and C6, edge of venous ulcer
2mm
Skin
Deep fascia
SEM Retrograde Resin Venography: Clinical C-4 Skin