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Point-Of-Care Ultrasound Screening for Proximal Lower Extremity Deep Venous Thrombosis
Published on: February 10, 2023
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The lower limb perforator veins in normal subjects.
Brigid G Hill1, André M van Rij1
1Department of Surgical Science, University of Otago, Dunedin, New Zealand.
Journal of Vascular Surgery. Venous and Lymphatic Disorders
|February 8, 2022
Summary
Normal leg perforator veins exhibit unidirectional flow from superficial to deep systems. Exercise significantly increases perforator flow, unlike augmentation maneuvers, which is crucial for assessing abnormal perforators.
Area of Science:
- Vascular Ultrasound
- Human Anatomy
- Physiology
Background:
- Vascular ultrasound advancements enable detailed examination of lower limb perforator veins.
- Understanding the normal function of perforators is essential for diagnosing venous diseases.
Purpose of the Study:
- To investigate the distribution, behavior, and functional characteristics of perforator veins in healthy lower limbs.
- To establish baseline data for normal perforator vein function using vascular ultrasound.
Main Methods:
- Ultrasound examination of lower limbs in 20 healthy participants.
- Evaluation of perforator anatomy, distribution, and flow dynamics at rest and during various maneuvers (supine, sitting, standing, exercise, isometric plantar flexion).
- Comparison of flow responses to standard augmentation and physiological maneuvers.
Main Results:
- An average of 14.2 perforators per limb were identified, with larger perforators predominantly in the lower medial calf.
- Valves were observed in 17% of larger direct perforators; flow was consistently unidirectional (superficial to deep).
- Exercise significantly increased perforator flow velocity and volume (up to five-fold), while augmentation maneuvers showed variable and less physiological flow.
Conclusions:
- Normal leg perforator veins demonstrate unidirectional flow from superficial to deep systems.
- Exercise is a key factor in recruiting perforators, substantially increasing flow.
- Physiological maneuvers like exercise are more representative of normal perforator function than augmentation techniques for clinical assessment.
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