In situ hemodynamics of perforating veins in chronic venous insufficiency

• Published in: Journal of vascular surgery 2001-04, Vol.33 (4), p.773-782
• Main Authors: Delis, Konstantinos T., Husmann, Marc, Kalodiki, Evi, Wolfe, John H., Nicolaides, Andrew N.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Blood and lymphatic vessels; Blood Flow Velocity; Blood Volume; Cardiology. Vascular system; Chronic Disease; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Humans; Leg - blood supply; Male; Medical sciences; Middle Aged; Prospective Studies; Pulsatile Flow; Regional Blood Flow; Ultrasonography, Doppler, Duplex; Veins - diagnostic imaging; Veins - physiopathology; Venous Insufficiency - physiopathology
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1067/mva.2001.112707

Purpose: The prevalence of incompetent perforators increases linearly with the clinical severity of chronic venous insufficiency (CVI) and the presence of deep vein incompetence. Putative transmission of deep vein pressure to skin may cause dermal hypoxia and ulceration. Despite extensive prospective interest in the contribution of perforators toward CVI, their hemodynamic role remains controversial. The aim of this prospective study was to determine the in situ hemodynamic performance of incompetent perforating veins across the clinical spectrum of CVI, by means of duplex ultrasonography. Methods: A total of 265 perforating veins of 90 legs that had clinical signs and symptoms consistent with CVI in 67 patients referred consecutively to the blood flow laboratory were studied. The clinical distribution of the examined limbs was CEAP0, 10 limbs; CEAP1-2, 39 limbs; CEAP3-4, 21 limbs; and CEAP5-6, 20 limbs. With the use of gated-Doppler ultrasonography on real-time B-mode imaging, the flow velocity waveforms were obtained from the lumen of perforators on release of manual distal leg compression in the sitting position and analyzed for peak and mean velocities, time to peak velocity, volume flow, venous volume displaced outward, and flow pulsatility. The diameter and duration of outward flow (abnormal reflux > 0.5 seconds) were also measured. Results: Incompetent perforators had bigger diameters, higher peak and mean velocities and volume flow, longer time to peak velocity, and bigger venous volume displaced outward (VVoutward) than competent perforators (all, P .1). Incompetent thigh and lower-third calf perforators had a significantly bigger diameter than perforators in the upper and middle calf combined (both, P .3); peak velocity was higher in those in CEAP3-4 than those in CEAP1-2 (P =.024); mean velocity in those in CEAP3-6 during the first second of reflux was twice that of those in CEAP1-2 (P