Journal of Vascular Surgery: Venous and Lymphatic Disorders
Clinical research studiesPerforating veinsThe lower limb perforator veins in normal subjects
Section snippets
Participants
Twenty-three participants were screened by ultrasound examination for the presence of venous disease; three were excluded. The remaining 20 individuals were healthy nonsmokers, free of any cardiovascular or venous disease, and were well-hydrated, not on any regular medications, and had not consumed caffeine drink in the 3 hours prior. Written informed consent was obtained as approved by the regional ethics committee.
Equipment
An Antares ultrasound machine (Siemens Medical Solutions, Inc. Mountain View,
Part 1. Perforator locations diameters and flow direction
Twenty individuals (13 females, 7 males; mean age, 36.9 ± 12 years) participated in the study. In the 20 legs assessed, 283 perforators were identified. There were 14.2 perforators identified per limb (range, 8-21; median, 13). After distal augmentation and Valsalva, none of the lower limb perforators were found to show an outward flow of more than 0.35 seconds, with all perforators demonstrating inward flow after the release of the calf or foot squeeze. Spontaneous flow was always inwards. The
Discussion
The careful ultrasound examination of the lower limbs in healthy individuals can now reveal many more perforators than previously reported either by earlier ultrasound methods or by phlebography.15,16 Even so, this number is far fewer than has been shown through anatomical cadaver dissections, which describe more than 150 perforators per limb. Currently, we can identify with ease perforators down to a diameter range of 0.4 mm. Below this size, however, detection ability is lost, and this factor
Conclusions
This study has shown that normal perforator veins in the leg are unidirectional and few have spontaneous flow at rest but most are recruited with exercise to substantially increase spontaneous flow. Isometric foot plantar flexion prevents spontaneous inflow, but after relaxation there is rapid inflow. These more physiological maneuvers provide a better reflection of normal perforator function than augmentation.
Author Contributions
Conception and design: BH, AvR
Analysis and interpretation: BH, AvR
Data collection: BH
Writing the article: BH, AvR
Critical revision of the article: BH, AvR
Final approval of the article: BH, AvR
Statistical analysis: BH, AvR
Obtained funding: AvR
Overall responsibility: BH
BH and AvR contributed equally to this article and share co-first authorship.
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This study was funded by Otago Vascular Diagnostics, University of Otago.
Author conflict of interest: none.
Additional material for this article may be found online at www.jvsvenous.org.
The editors and reviewers of this article have no relevant financial relationships to disclose per the Journal policy that requires reviewers to decline review of any manuscript for which they may have a conflict of interest.