The association between the “T” vein and ulceration of the lateral aspect of the leg

Abstract

The “T” vein is a tributary of The Great Saphenous Vein (GSV) located in the upper third of the leg with a perpendicular course to the GSV. It usually crosses the tibial bone and feeds by reflux of varicose veins of the lateral aspect of the leg. It is of surgical interest because it is involved with a significant percentage of varicose networks. The aim of this study is to analyze the prevalence of the T vein pattern in a cohort of patients affected by Chronic Venous Insufficiency (CVI), as well as its possible association with Venous Leg Ulcers (VLU) of the lateral aspect of the leg. One thousand nine hundred and twenty-two consecutive patients (1441 females and 481 males) were evaluated from January 2013 to May 2024 by means of clinical examination and the same Duplex Ultrasound Scanning (DUS) protocol. We assessed the frequency of patients presenting with the T vein pattern and the percentage of patients in which it causes symptomatic reflux. We also evaluated the susceptibility, respectively in the T vein and in the CVI cohort, of venous ulcerations (C5-C6 clinical classes according to the Clinical, Etiological, Anatomical, and Pathophysiological, CEAP, classification) in the medial and/or in the medial and lateral aspect of the leg vs exclusively in the lateral aspect of the leg. A p-value <0.05 has been considered significant. Overall, the presence of the T vein pattern was observed in 64 patients (3.33%). There is no statistically significant difference in the prevalence of T vein configuration in males (4.16%) and in females (3.05%) (p-value=0.24). A bilateral T vein pattern has been detected in just one case. T vein was involved in varicose vein networks, with only 2 patients being asymptomatic and without signs of CVI (3.1%). Noteworthy VLU (C5-C6) affected respectively 10 patients of the T vein cohort and 74 of the control population; in the T vein cohort, 80% of patients presented with VLU in the lateral perimalleolar region, while 72.9% of patients in the control group had VLU in the typical medial perimalleolar area (p-value=0.000852). Sometimes the clinician is doubtful about the venous pathogenesis of ulcerations visible in the lateral area of the leg. Our study suggests in these cases to investigate by DUS an eventual reflux coming from the T vein.

Keywords

• Tributary
• reflux
• leg ulcers
• CHIVA
• ligation