[Perforating veins and venous insufficiency]

As communicating link between the deep and the superficial venous system the perforating veins are of special importance. With the introduction of the subfascial videoendoscopic dissection of the perforating veins the interest in anatomic and topographic aspects of the surgical treatment of insufficient perforators has increased. Different pathophysiological conditions can cause insufficient perforating veins. We can distinguish between a primary form and a secondary form caused by an advanced varicosis of the main superficial veins. A third entity consists in an insufficiency created by a postthrombotic alterations of the deep venous system. Primary insufficient perforators should be treated surgically. In the case of a secondary insufficiency the indication is dependent on the extent of the pathological findings. If there is an obstruction of the deep venous system which causes the insufficiency of a perforator the vein should not be divided. The videoendoscopic subfascial dissection of the insufficient perforating veins has several advantages compared with direct percutaneous exposure. The technique is easy to learn, however it requires profound knowledge about the compartmental spaces and the topographic anatomy of the perforating veins in the lower leg.