Valvular Density Alone Cannot Account for Sites of Chronic Venous Insufficiency and Ulceration in the Lower Extremity

Abstract

This study shows that the density of venous valves is actually higher in regions of the human lower extremity overlying bones and tendons, where venous stasis ulcers are common, than those overlying muscular areas, where ulcers are rarely seen. Thus, valvular quantity alone cannot account for the higher clinical incidence of ulceration. It is likely that muscular pumping and/or valvular quality are important factors in preventing the development of venous stasis and ulceration in the lower extremity.

Micro‐venous valves in the superficial veins of the human lower limb

“…The finding of venous valves in the smallest of the superficial veins in the leg is consistent with several recent studies where valves have been found in the small superficial veins of the anterior abdominal wall (Braverman and Keh-Yen, 1983), the deep veins of the face (Miyake et al, 1996), the superficial veins of the dorsal thorax (Aharinejad et al, 1997), and the superficial veins of the lower limb and foot (Aharinejad et al, 2001). The smallest size of veins reported to have valves varies, ranging from 18 m in the lower limb (the present study and Aharinejad et al, 2001), 30 m in the thorax (Aharinejad et al, 1997), 40 m in the abdominal wall (Braverman and Keh-Yen, 1983) to 150 m in the maxillofacial region (Miyake et al, 1996).…”

“…Venous valves were identified by the slit in the resin (Figs. 1,3) that showed the location of the venous valve cusp, as described previously (Miyake et al, 1996;Aharinejad et al, 1997Aharinejad et al, , 2001.…”

“…Aharinejad et al (1997) used SEM, transmission electron microscopy, and light microscopy to investigate the venous valves of the human dorsal thoracic fasciocutaneous tissue. They found that venous valves were present in veins as small as 30 m in luminal diameter, the majority of which were present in veins with a diameter of 30 -120 m. More recently, venous valves have been identified in the small superficial veins of the foot and lower limb (Aharinejad et al, 2001). Using resin casting and SEM, Aharinejad et al (2001) identified and quantified valves in the small superficial veins of the human lower limb and foot.…”

“…They found that venous valves were present in veins as small as 30 m in luminal diameter, the majority of which were present in veins with a diameter of 30 -120 m. More recently, venous valves have been identified in the small superficial veins of the foot and lower limb (Aharinejad et al, 2001). Using resin casting and SEM, Aharinejad et al (2001) identified and quantified valves in the small superficial veins of the human lower limb and foot. They found venous valves as small as 18 m in diameter in the sampled tissue, with the majority of the valves being present in veins 100 -300 m in luminal diameter.…”

Valvular Mapping of Rectus Abdominis and Latissimus Dorsi Muscles

“…venous insufficiencymediated ulcerations in the lower limb [1]. The ulcerations caused by venous insufficiency are often accompanied by pathologic hemodynamics and abnormal venous valves [2][3]. The aim of this study was to elucidate the venous valvular density in rectus abdominis and latissimus dorsi muscles, and thus to examine their benefit in reconstructive surgery [4].…”