Which Way Does Blood Flow in the Perforating Veins of the Leg?

1991 ◽  
Vol 6 (2) ◽  
pp. 127-132 ◽  
Author(s):  
G. M. McMullin ◽  
P. D. Coleridge Smith ◽  
J. H. Scurr
Keyword(s):  
Blood Flow ◽  
Ultrasound Imaging ◽  
Clinical Evidence ◽  
Duplex Ultrasound ◽  
Venous Disease ◽  
Distal Limb ◽  
Perforating Veins ◽  
Perforating Vein ◽  
Precise Role

There is controversy about the precise role of calf perforating veins in venous disease. Previous studies have shown that the direction of flow is principally inward and that outward flow may be used as a means of diagnosing perforator ‘incompetence’. Fifty-six perforating veins in 25 patients with clinical evidence of venous disease were examined using duplex ultrasound imaging. Only one perforating vein showed outward flow on distal compression of the limb, whereas local compression elicited outward flow in 38. Distal limb compression cannot be used to assess the ‘competence’ of calf perforating veins.

Duplex ultrasound investigation of the veins in chronic venous disease of the lower limbs – UIP Consensus Document. Part II: Anatomy

2006 ◽  
Vol 21 (4) ◽  
pp. 168-179 ◽  
Author(s):  
A Cavezzi ◽  
N Labropoulos ◽  
H Partsch ◽  
S Ricci ◽  
A Caggiati ◽  
...  
Keyword(s):  
Lower Limb ◽  
Duplex Ultrasound ◽  
Lower Limbs ◽  
Chronic Venous Disease ◽  
Specific Reference ◽  
Venous Disease ◽  
Perforating Veins ◽  
Consensus Document ◽  
Wide Range ◽  
Ultrasound Investigation

Objectives: Duplex ultrasound investigation has become the reference standard in assessing the morphology and haemodynamics of the lower limb veins. The project described in this paper was an initiative of the Union Internationale de Phlébologie (UIP). The aim was to obtain a consensus of international experts on the methodology to be used for assessment of the anatomy of superficial and perforating veins in the lower limb by ultrasound imaging. Design: Consensus conference leading to a consensus document. Methods: The authors performed a systematic review of the published literature on duplex anatomy of the superficial and perforating veins of the lower limbs. Afterwards, they invited a group of experts from a wide range of countries to participate in this project. Electronic submissions from the authors and the experts (text and images) were made available to all participants via the UIP website. The authors prepared a draft document for discussion at the UIP Chapter meeting held in San Diego, USA, in August 2003. Following this meeting, a revised manuscript was circulated to all participants and further comments were received by the authors and included in subsequent versions of the manuscript. Eventually, all participants agreed on the final version of the paper. Results: The experts have made detailed recommendations concerning the methods to be used for duplex ultrasound examination as well as the interpretation of images and measurements obtained. This document provides a detailed methodology for complete ultrasound assessment of the anatomy of the superficial and perforating veins in the lower limbs. Conclusions: The authors and a large group of experts have agreed on a methodology for the investigation of the lower limbs venous system, by duplex ultrasonography, with specific reference to the anatomy of the main superficial veins and perforators of the lower limbs in healthy and varicose subjects.

Perforating veins incompetence. Clinical aspects and evaluation mode

2021 ◽  
pp. 45-52
Author(s):  
Olga Yaroslavna Porembskaya ◽  
Sergey Igorevich Mozgunov ◽  
Mikhail Shakirovich Chesnokov ◽  
Viacheslav Nikolaevich Kravchuk
Keyword(s):  
Literature Review ◽  
Clinical Impact ◽  
Diagnostic Evaluation ◽  
Chronic Venous Disease ◽  
Clinical Aspects ◽  
Venous Disease ◽  
Disease Development ◽  
Perforating Veins ◽  
Evaluation Mode ◽  
Perforating Vein

This manuscript represents a literature review on evaluation mode of perforating vein incompetence and its clinical impact on chronic venous disease development. Perforating veins (PV) serve as a complex anatomical and functional structure which incompetence indicates possible pathological processes in superficial and deep veins. PV almost never become a reflux source and though never require to be treated to abolish its incompetence. At the same time accurate diagnostic evaluation of PV condition must be performed to distinguish PV incompetence from PV compensatory changes that correct effects of vertical venous refluxes.

scholarly journals Varicose vein appearance caused by perforating vein incompetence detected after intense cycling

2017 ◽  
Vol 5 ◽  
pp. 2050313X1774749
Author(s):  
Charlotte E Davies ◽  
Angie M White ◽  
Mark S Whiteley
Keyword(s):  
General Population ◽  
Varicose Vein ◽  
Varicose Veins ◽  
Lower Leg ◽  
Venous Reflux ◽  
Perforating Veins ◽  
Competitive Cyclists ◽  
Left Calf ◽  
Perforating Vein

The role of incompetent perforating veins in the aetiology of varicose veins is not well understood. Anecdotally, competitive cyclists appeared to be more prone to varicose veins than the general population. We present a case of a 63-year-old amateur competitive cyclist who acutely developed a painful varicosity of her left calf while straining during a hill climb in 106-mile cycle race. Duplex ultrasonography has shown an underlying incompetent perforating vein, feeding the varicosity directly through the underlying muscle. With no other significant venous reflux in either leg, we believe this case shows a clear causative association between the stresses put across the lower leg during competitive cycling and developing a varicose vein via an incompetent perforating vein. We believe this should lead to further investigations as to any link between cycling, perforator vein incompetence and the development of varicose veins.

scholarly journals Matched increases in cerebral artery shear stress, irrespective of stimulus, induce similar changes in extra-cranial arterial diameter in humans

2017 ◽  
Vol 39 (5) ◽  
pp. 849-858 ◽  
Author(s):  
Kurt J Smith ◽  
Ryan L Hoiland ◽  
Ryan Grove ◽  
Hamish McKirdy ◽  
Louise Naylor ◽  
...  
Keyword(s):  
Blood Flow ◽  
Shear Stress ◽  
Shear Rate ◽  
Duplex Ultrasound ◽  
Arterial Dilation ◽  
Cranial Arteries ◽  
First Time ◽  
Carotid And Vertebral Arteries

The mechanistic role of arterial shear stress in the regulation of cerebrovascular responses to physiological stimuli (exercise and hypercapnia) is poorly understood. We hypothesised that, if shear stress is a key regulator of arterial dilation, then matched increases in shear, induced by distinct physiological stimuli, would trigger similar dilation of the large extra-cranial arteries. Participants ( n = 10) participated in three 30-min experimental interventions, each separated by ≥48 h: (1) mild-hypercapnia (FICO2:∼0.045); (2) submaximal cycling (EX; 60%HRreserve); or (3) resting (time-matched control, CTRL). Blood flow, diameter, and shear rate were assessed (via Duplex ultrasound) in the internal carotid and vertebral arteries (ICA, VA) at baseline, during and following the interventions. Hypercapnia and EX produced similar elevations in blood flow and shear rate through the ICA and VA ( p < 0.001), which were both greater than CTRL. Vasodilation of ICA and VA diameter in response to hypercapnia (5.3 ± 0.8 and 4.4 ± 2.0%) and EX (4.7 ± 0.7 and 4.7 ± 2.2%) were similar, and greater than CTRL ( p < 0.001). Our findings indicate that matched levels of shear, irrespective of their driving stimulus, induce similar extra-cranial artery dilation. We demonstrate, for the first time in humans, an important mechanistic role for the endothelium in regulating cerebrovascular response to common physiological stimuli in vivo.

Telangiectases in Venous Insufficiency: Point of Reflux and Treatment Strategy

2000 ◽  
Vol 15 (1) ◽  
pp. 38-42 ◽  
Author(s):  
F. Mariani ◽  
V. Bianchi ◽  
S. Mancini ◽  
S. Mancini
Keyword(s):  
Venous Insufficiency ◽  
Duplex Ultrasound ◽  
Average Diameter ◽  
Venous System ◽  
Lower Limbs ◽  
Perforating Veins ◽  
Ceap Classification

Objective: To verify the role of sources of non-saphenous reflux in the appearance of reticular varices and telangiectases in areas other than the lateral venous system of Albanese. Setting: Institute of General Surgery and Surgical Specialisations, Interdepartmental Centre of Research, Treatment and Phlebolymphological Rehabilitation, University of Siena. Patients and methods: The study was carried out on 106 women aged 18–65 years who were affected by chronic venous insufficiency (CVI) at the Cla-s Ep Asl stage, according to the CEAP classification. The patients had telangiectases (200 telangiectactic areas) and reticular varices of the lower limbs of type II and III of the classification of Weiss, with competent saphenous trunks and a normal deep venous system. Sclerotherapy was therefore performed, after clinical and duplex ultrasound examination. The records of 185 telangiectactic area treated 3 years earlier were reviewed. Results: In all cases reticular varices was found together with the telangiectases. In 73.5% (147/200 areas) one or more incompetent perforating veins was found (average diameter 1.6 mm) and in 83.6% (123/147 areas) it was possible to establish that the main source of reflux was in the base of the telangiectasia. Complete elimination of microvarices was achieved in 88% of cases (176/200 areas; average sessions: 3.5). The complications were haemosiderin pigmentation (1.5%, 3/200 areas) and matting (1%, 2/200 areas). In 24 areas resistant to the therapy it was not possible to demonstrate the presence of reflux, while in 24.5% of cases (49/200 areas, average surface 15.4 cm2) two sessions of sclerotherapy were sufficient eventually to obtain (about 4 weeks later) the disappearance of the micro-varices. Follow-up after 3 years revealed the appearance of new telangiectases in 58.9% of cases (109/185 check-ups). Of these 95.4% (104/109) arose in areas other than those treated and therefore only 4.6% (5/109) recurred in the area where the sclerosing treatment had been carried out. Conclusion: In CVI all telangiectases are accompanied by reticular varices, even when not visible on clinical examination; in most cases the sources of reflux are distinguishable as incompetent perforating veins and are situated beneath telangiectactic efflorescences.

Duplex ultrasound investigation of the veins in chronic venous disease of the lower limbs-UIP consensus document. Part II. Anatomy

VASA ◽  
2007 ◽  
Vol 36 (1) ◽  
pp. 62-71 ◽  
Author(s):  
Cavezzi ◽  
Labropoulos ◽  
Partsch ◽  
Ricci ◽  
Caggiati ◽  
...  
Keyword(s):  
Lower Limb ◽  
Duplex Ultrasound ◽  
Lower Limbs ◽  
Chronic Venous Disease ◽  
Specific Reference ◽  
Venous Disease ◽  
Perforating Veins ◽  
Consensus Document ◽  
Wide Range ◽  
Ultrasound Investigation

Background: Duplex ultrasound investigation has become the reference standard in assessing the morphology and haemodynamics of the lower limb veins. The project described in this paper was an initiative of the Union Internationale de Phlébologie (UIP). The aim was to obtain a consensus of international experts on the methodology to be used for assessment of anatomy of superficial and perforating veins in the lower limb by ultrasound imaging. Methods: The authors performed a systematic review of the published literature on duplex anatomy of the superficial and perforating veins of the lower limbs; afterwards they invited a group of experts from a wide range of countries to participate in this project. Electronic submissions from the authors and the experts (text and images) were made available to all participants via the UIP website. The authors prepared a draft document for discussion at the UIP Chapter meeting held in San Diego, USA in August 2003. Following this meeting a revised manuscript was circulated to all participants and further comments were received by the authors and included in subsequent versions of the manuscript. Eventually, all participants agreed the final version of the paper. Results: The experts have made detailed recommendations concerning the methods to be used for duplex ultrasound examination as well as the interpretation of images and measurements obtained. This document provides a detailed methodology for complete ultrasound assessment of the anatomy of the superficial and perforating veins in the lower limbs. Conclusions: The authors and a large group of experts have agreed a methodology for the investigation of the lower limbs venous system by duplex ultrasonography, with specific reference to the anatomy of the main superficial veins and perforators of the lower limbs in healthy and varicose subjects.

Secondary findings in duplex ultrasound of leg veins

Phlebologie ◽  
2017 ◽  
Vol 46 (03) ◽  
pp. 155-162
Author(s):  
J. Woitalla ◽  
G. Bruning ◽  
N. Devereux
Keyword(s):  
Blood Flow ◽  
Gold Standard ◽  
Ultrasound Examination ◽  
Duplex Ultrasound ◽  
Ultra Sound ◽  
Venous Disease ◽  
Noninvasive Diagnosis ◽  
Secondary Findings ◽  
Venous Diseases ◽  
Colour Coding

SummaryThe diagnosis of venous diseases and abnormalities has gained a new dimension with duplex ultrasound, which is now regarded as the gold standard for leg vein examination. The combination of B scan, doppler and colour-coding of the blood flow in duplex ultra-sound offers a simple, highly predictive, noninvasive diagnosis of venous disease. It provides important information not only on the haemodynamic function but also on the patient‘s anatomy, allowing a diagnostic look left, look right“. As a result, secondary findings frequently crop up during systematic duplex ultrasound examination of the superficial and deep leg veins. This Advanced Learning in Pictures presents the most common secondary findings in vein surgery consultations.

scholarly journals Thrombogenesis with continuous blood flow in the inferior vena cava

2010 ◽  
Vol 104 (08) ◽  
pp. 366-375 ◽  
Author(s):  
Angela Hawley ◽  
Christine Alvarado ◽  
Alexandra Berguer ◽  
Nichole Baker ◽  
Shirley Wrobleski ◽  
...  
Keyword(s):  
Electron Microscopy ◽  
Blood Flow ◽  
Inferior Vena Cava ◽  
Ultrasound Imaging ◽  
Inferior Vena ◽  
Thrombus Formation ◽  
Vena Cava ◽  
Venous Disease ◽  
A Current ◽  
Pai 1

SummarySeveral rodent models have been used to study deep venous thrombosis (DVT). However, a model that generates consistent venous thrombi in the presence of continuous blood flow, to evaluate therapeutic agents for DVT, is not available. Mice used in the present study were wild-type C57BL/6 (WT), plasminogen activator inhibitor-1 (PAI-1) knock out (KO) and Delta Cytoplasmic Tail (ΔCT). An electrolytic inferior vena cava (IVC) model (EIM) was used. A 25G stainless-steel needle, attached to a silver coated copper wire electrode (anode), was inserted into the exposed caudal IVC. Another electrode (cathode) was placed subcutaneously. A current of 250 μAmps over 15 minutes was applied. Ultrasound imaging was used to demonstrate the presence of IVC blood flow. Analyses included measurement of plasma soluble P-selectin (sP-Sel), thrombus weight (TW), vein wall morphometrics, P-selectin and Von Willebrand factor (vWF) staining, transmission electron microscopy (TEM), scanning electron microscopy (SEM); and the effect of enoxaparin on TW was evaluated. A current of 250 μAmps over 15 minutes consistently promoted thrombus formation in the IVC. Plasma sPSel was decreased in PAI-1 KO and increased in ΔCT vs. WT (WT/PAI-1: p=0.003, WT/ΔCT: p=0.0002). Endothelial activation was demonstrated by SEM, TEM, P-selectin and vWF immunohistochemistry and confirmed by inflammatory cell counts. Ultrasound imaging demonstrated thrombus formation in the presence of blood flow. Enoxaparin significantly reduced the thrombus size by 61% in this model. This EIM closely mimics clinical venous disease and can be used to study endothelial cell activation, leukocyte migration, thrombogenesis and therapeutic applications in the presence of blood flow.

Toe elevation manoeuvre to assess venous reflux in comparison to manual calf compression and release

VASA ◽  
2016 ◽  
Vol 45 (4) ◽  
pp. 299-304 ◽  
Author(s):  
Michael Habenicht ◽  
Eberhard Rabe ◽  
Felix Amsler ◽  
Erika Mendoza
Keyword(s):  
Blood Flow ◽  
Duplex Ultrasound ◽  
Previous Treatment ◽  
Standing Position ◽  
Chronic Venous Disease ◽  
Valsalva Manoeuvre ◽  
Venous Disease ◽  
Significant Difference ◽  
Calf Compression ◽  
Proximal Thigh

Abstract. Background: In the daily office setting, flow and reflux in leg veins is assessed to investigate patients with chronic venous disease. Valsalva manoeuvre and manual calf compression and release are frequent manoeuvres used to elicit blood flow in leg veins. Toe elevation manoeuvre (TEM) was proposed as a further alternative to provoke blood flow in veins. We compared both methods. Patients and methods: Patients consulting a venous office referring no previous treatment on their leg veins were evaluated with duplex ultrasound in the standing position. Age, body mass index, C of CEAP, venous clinics severity score, diameter of great saphenous vein and reflux duration at proximal thigh following TEM and manual calf compression and release were assessed. Results: In total, 53 legs were evaluated with both manoeuvres, applied in a randomised sequence. Reflux >0.5s was found in 40 legs (group “reflux”) and no reflux in 13 legs (group “no reflux”). No significant difference was found following manual calf compression and release or TEM (2.11s vs. 2.31s in “reflux-group” and 0.11s vs. 0.13s in “no-reflux-group”), but good correlation was found between both with Pearson’s test (r=0.72). Conclusions: Both manoeuvres showed a good correlation with respect to reflux detection and reflux duration. The advantage of TEM is the easy and painless performance, low fatigability and independence from examiner.

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