The functional characteristics of normal venous perforators as observed with duplex ultrasound

venous perforator;duplex

Hill, Brigid Geraldine ; van Rij, Andre ; Jones, Greg

University of Otago

关键词: venous perforator;    duplex;   

Others  :  https://ourarchive.otago.ac.nz/bitstream/10523/1991/3/HillBrigidG2011MHealSc.pdf..pdf

美国|英语

来源: Otago University Research Archive

【 摘 要 】

Varicose veins are an extremely common condition, with significant challenges in regard to the best approach to the management of incompetent venous perforators. In order to better understand the role of the venous perforator in venous disease, we set out to understand how venous perforators function in a normal population.Venous perforator were examined using duplex ultrasound in twenty healthy volunteers with normal venous function. The diameter, distribution, and communication of all lower limb perforators was assessed. This was followed by a more detailed assessment of the perforators along the tibial and paratibial region of the medial calf. Participants were examined in three different positions to further assess changes in function. The anatomical appearance of the perforator was also investigated, particularly the communications between compartments, as was the ability to detect perforator valves using high-resolution ultrasound. The effect of venous surgery on perforator distribution and recurrent rates over a three-year time period was also studied based on ultrasound findings. A comparison was made between the normal and diseased population with regard to regional distribution, diameter and communication of the perforators. Resin casts were made of normal venous systems of the medial calf and the perforator characteristics examined and compared with ultrasound findings. The study found that the diameter of the medial calf perforator in the gaiter region to be the most significant among normal subjects. The medial calf was found to have no obvious difference in relation to venous blood velocities on distal augmentation in the standing position when compared to a planter flexion / isometric contraction. Neovasculization occurred in surgical ligated venous perforators. Resin casts of perforators more clearly demonstrate the presents of valves and multiple channels. The perforators between the superficial and deep compartments of the venous system of the lower leg remains difficult to truly understand. The distal medial calf perforators in the normal population had a larger diameter, greater blood flow and higher velocities suggesting that these perforators may exist in a more demanding environment and be more susceptible to failure. This may play a key role in maintaining normal venous unction. Incompetence in this region could be of greater significance in a diseased population. While some valves were identified on duplex ultrasound, resin casting demonstrated the presence of valves in all perforators of the medial calf. This provided a cautionary message as to the limitations of even the best in diagnostic ultrasound.