Associations between flow in paratibial perforating veins and great saphenous vein patterns of reflux

Abstract

Perforating veins contribute to chronic venous valvular insufficiency (CVVI, subset of CVI) of lower extremities (LE). We investigated the role of medial, proximal calf paratibial perforating veins (PTPV). Women with PTPV reflux, diameter ≥3 mm, or tortuosity were selected among 2199 LE mappings. Duplex ultrasonography (US) was performed standing. Reflux >0.5 s was abnormal. PTPV conditions were related to great saphenous vein (GSV) patterns of reflux. US of 442 LE of 379 women were analyzed, all being Clinical-Etiology-Anatomy-Pathophysiology (CEAP) classification C1, C2, and/or having intermittent, conditional swelling. Etiology was primary. Pathophysiology was reflux, not thrombosis or obstruction. Most PTPV drained (n=281, 64% of 442 or 13% of 2199), or were source (n=73, 17%/442, 3%/2199) of GSV reflux; 49 (11%/442, 2%/2199) had reflux not associated with GSV; 39 (9%/442, 2%/2199) did not have reflux. PTPV, when significative for CVVI, primarily drained-GSV reflux. PTPV was linked to reflux in 1 of 5 and was a major source of reflux in 1 of 20 legs. Detailed US of PTPV insured over 80% accuracy in CVVI mapping.

Keywords

• Venous valvular insufficiency
• duplex-Doppler ultrasound
• great saphenous vein
• paratibial perforating vein.