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Venae perforantes: a clinical review
Pierre Antonius Franciscus Alexius van Neer1, Joep Cristianus Jacobus Maria Veraart, Hendrik Arent Martino Neumann
1Laurentius Hospital, Roermond University Hospital, Maastricht Erasmus Medical Center, Rotterdam, the Netherlands. dermatologie1@lzr.nl
Summary
Incompetent perforating veins significantly impact venous ulceration and recurrent varicose veins. Current definitions and classifications aid in selecting surgical (SEPS) or sclerotherapy treatments for these hemodynamically important vessels.
Area of Science:
- Vascular Surgery
- Phlebology
- Venous Disease Research
Background:
- Limited comprehensive knowledge exists regarding perforating veins despite numerous publications.
- Perforating veins play a crucial, yet often underestimated, role in venous pathophysiology.
Purpose of the Study:
- To review and synthesize key facts on the clinical significance of perforating veins in venous disorders.
- To consolidate current understanding and guide clinical practice regarding perforating vein evaluation and management.
Main Methods:
- Extensive literature search across English, French, and German articles.
- Utilized major medical databases including Medline, Embase, and Cochrane.
- Defined selection criteria for relevant studies on perforating veins.
Main Results:
- Incompetent perforating veins demonstrate significant hemodynamic impact, particularly in venous ulceration and recurrent varicose veins.
- Established definition for incompetent perforating veins: reflux >0.5 seconds via Duplex ultrasonography.
- Identified and recommended integration of existing anatomical and clinical classifications into the CEAP system.
Conclusions:
- Incompetent perforating veins are hemodynamically critical, especially in complex venous conditions.
- Proposed treatment strategies based on clinical classification, including surgery (SEPS) and sclerotherapy.
- SEPS shows benefit in advanced chronic venous insufficiency (CVI) with ulceration; ultrasound-guided sclerotherapy warrants further investigation.