Disclosure Nicos Labropoulos, PhD, RVT

I disclose the following financial relationship(s):

•Speaker/Honoraria: Cook

•Consultant/Advisory Board: Cook, Covidien

Thigh, Calf & Ankle Perforators:

Are They Different?

Nicos Labropoulos

Professor of Surgery and Radiology

Director, Vascular Laboratory

Division of Vascular Surgery

Stony Brook University Medical Center

Stony Brook, New York, USA

Limborgh J van. Folia Angiol 1961;8: 240-57

About 150

perforator veins

About 30

perforator veins

most commonly

incompetent

Labropoulos N, et al.

EJVES 1999;18:228-34

Labropoulos N, et al.

EJVES 1999;18:228-34

More muscle mass

longer distance

longer veins

Higher number

More often duplicated

axial vein

muscular vein

Ascending reflux

Re-entry veins that

eventually become

incompetent

Descending process

Labropoulos N, et al.

J Vasc Surg 2006;43:558-62

More often associated

with skin damage

Labropoulos N, et al.

J Vasc Surg 1995;22:45-50

Labropoulos N, et al.

J Vasc Surg 2006;43:558-62

Labropoulos N, et al.

Vasc Endovascular Surg

2007; 41; 33

Midcalf medial duplicated PV

Normal Incompetent

Inward and outward flow

Outward flow

Inward flow

Labropoulos N et al. EJVES 1999;18:228-34

Lower calf posterolateral PV

Labropoulos N, et al. J Vasc Surg 2003;38:793-8

Reflux cut-off values

Superficial veins >500ms

Perforator veins >350ms

Calf veins + Deep femoral >500ms

Femoropopliteal veins >1000ms

Labropoulos N, et al. J Vasc Surg 2006;43:558-62

Perforator vein reflux development

29 limbs in 26 patients with PV reflux development.

In total 38 new incompetent PVs were identified.

The median time for the examination was 25

months (range 9 to 52).

Midthigh medial PV reflux

Reflux in a previously normal PV at a re-entry site

was detected in 15.

In ascending manner from extension of superficial

vein reflux in 18.

In a new previously intact location in 5.

Tributary reflux 27 months later ascending

reflux in a perforator vein

Lower calf medial 44 months later descending reflux

Midcalf medial 38 months later reflux in a new location

N

R

R

R

R

N

N

Female 53y, 2 pregnancies, FH: +ve, DOD: 14y

C1-2A EP AS PR C1-3A EP AS PR

First exam

R

N

N N R

N

R

R

R

R

R

R

N

N

Female 53y, 2 pregnancies, FH: +ve, DOD: 17y

R

R

C1-3A EP AS+P PR C1-4S EP AS+P PR

2nd exam at

38 months

R R

R

N

N R

Ascending

New

Descending

Labropoulos N, et al. J Vasc Surg 1997;26:743-8

Pathologic perforator?

Large diameter with reflux associated with patients

signs and symptoms

8.5mm 6.4mm

Retrograde Resin Venography

Venous Insufficiency

Clinical class 4-6

Prof. Andre van Rij

Chairman

Department of Surgery

Retrograde Resin Venography

Boundary Valves

C4 and C6, edge of venous ulcer

2mm

Skin

Deep fascia

SEM Retrograde Resin Venography: Clinical C-4 Skin