Minimally invasive surgery for perforator vein incompetence

Color Duplex Ultrasound in the Assessment of Primary Venous Leg Ulceration

“…Incompetent perforating vein valves transmit the high pressure in the deep veins directly to the superficial veins, which interferes with the circulation and results in ulceration. Saharay and Scurr classified four types of perforating incompetence 6 in which an incompetent perforator that is a source of reflux into the superficial venous system causes venous ulceration. Burnand described primary perforating venous incompetence as being due to an inherited weakness of the vein wall, which can affect all the perforating veins 7 .…”

“…However, ligation of incompetent perforating veins without management of concomitant insufficiency produced minimal clinical and hemodynamic improvement. CFDI allows direct visualization of underlying venous reflux including the perforating veins, and is useful for establishing both the anatomical location and extent of the venous incompetence 6 …”

Venae Perforantes: A Clinical Review

“…Based on the different pathogenetic ways, PVs may become incompetent; several authors have developed a clinical classification of IPVs. They base this classification on the presence of IPV and reflux in other segments of the venous systems 30–33 . In summarizing these classifications, one might conclude that there are five clinical different types of IPVs (Table 1).…”

“…There are several studies on the presence of IPV in patients with recurrent varicosis. Most studies show a high prevalence of IPV in patients with recurrent varicose veins after surgery, 6–74 especially incompetent thigh PVs 37,75,76,77 . Although there seems to be an association between IPV and recurrent varicose veins, it is now essential to establish whether this is a causative link 73 …”

“…According to Stuart et al, 30 much of the controversy about the appropriateness of perforator ligation could be caused by differences in case mix and selection between series. Several authors proposed to differentiate between clinical types of IPV when selecting patients for perforator therapy 30–33 …”