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Updated: Nov 1, 2025
Point-Of-Care Ultrasound Screening for Proximal Lower Extremity Deep Venous Thrombosis
Published on: February 10, 2023
[Connection of perforating and intramuscular veins of the crus in varicosity]
A B Sannikov1, V M Emel'ianenko1, S A Solokhin2
1Department of Additional Professional Education of Healthcare Specialists, Russian National Research Medical University named after N.I. Pirogov, Moscow, Russia.
Insights
This study used MSCT phlebography to map calf perforating veins and their connection to intramuscular veins in 400 patients. Findings reveal perforating and intramuscular veins contribute to chronic venous insufficiency progression.
Area of Science:
- Vascular anatomy
- Medical imaging
- Phlebology
Background:
- Chronic venous insufficiency (CVI) affects a significant portion of the population.
- Understanding the anatomical basis of CVI is crucial for effective treatment.
- Indirect perforating veins and intramuscular venous collectors play a role in venous hemodynamics.
Purpose of the Study:
- To investigate the clinical anatomy of indirect perforating veins.
- To examine their connection to the intramuscular venous collector of the crus.
- To utilize multislice computed tomography (MSCT) phlebography for detailed visualization.
Main Methods:
- MSCT phlebography was performed on 400 patients with chronic lower limb venous diseases (CEAP C0-C6).
- Examinations utilized a 128-slice CT scanner with 3D reconstruction software.
- Detailed anatomical mapping of perforating veins was conducted.
Main Results:
- A total of 11,655 indirect perforating veins were identified across different anatomical groups.
- 3D imaging allowed tracing the entire course of perforating veins to intramuscular collectors (gastrocnemius and soleus veins).
- Ectasia and pathological hypervolemia were observed in intramuscular venous collectors as the disease progresses.
Conclusions:
- Perforating veins and intramuscular veins of the crus are involved in the pathohamodynamic circle of CVI development and progression.
- These findings highlight the interconnectedness of superficial and deep venous systems in varicose vein disease.
- The study provides detailed anatomical insights into the mechanisms underlying chronic venous insufficiency.
Aim:
This study was undertaken to investigate the clinical anatomy of indirect perforating veins and their connection to the intramuscular venous collector of the crus by means of MSCT phlebography.
Patients And Methods:
From 2015 till now, MSCT phlebography was used to examine a total of 400 patients with chronic diseases of lower limb veins. According to the CEAP classification, clinical class C0-C1 was present in 108 (27%) subjects, C2-C3 - in 173 (43.3%) patients, and C4-C6 - in 119 (29.7%) patients. All examinations were performed using a 128-slice multispiral CT scanner Philips Ingenuity, followed by 3D reconstruction with the help of the IntelliSpace Portal Image Editing Software package.
Results:
In the 400 extremities examined, we identified a total of 11 655 indirect perforating veins of the calf. Studying the anatomical localization of perforating veins demonstrated that 3248 veins belonged to the posterior tibial group, 1830 veins - to the lateral group, 873 veins - to the paraachillary group, 276 veins - to the intergemellary group, 4451 veins - to the medial group, and 997 perforating veins - to the lateral group. 3D imaging made it possible to trace the entire course of the perforating veins originating from the posterior arched, intersaphenous, oblique veins or other communicating branches to the subfascial and intramuscular portions to the connection with the gastrocnemius and soleus veins which as the disease progresses undergo ectasia with the formation therein of pathological segmental hypervolemia.
Conclusion:
Studying the ratio of the revealed indirect perforating veins of the determined groups and the presence of gradually developing ectasia of the intramuscular venous collectors in patients of various clinical classes from C0-C1 to C4-C6 made it possible to draw a conclusion on the involvement of perforating veins and intramuscular veins of the crus into the common pathohaemodynamic circle of the development and progression of chronic venous insufficiency in patients with varicose veins.
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