A Reassessment of the Role of Perforating Veins in Chronic Venous Insufficiency

Abstract

Ambulatory venous hypertension is closely associated with the signs and symptoms of venous disease. It has been shown that reverse flow of blood in the superficial and deep veins is responsible. The pressure derangement caused by incompetence of perforating veins has not been established. The present study documents the pressure disturbances caused by incompetence in each of the three compartments of the venous system, the deep, the superficial and the perforating veins. In total 90 limbs of 49 patients with chronic venous insufficiency were examined and classified by duplex scanning and ascending venography. Ambulatory venous pressure measurements were performed on all 90 limbs and a venous sufficiency index (VSI) for each limb calculated from the percentage drop in pressure and refilling time. VSI was lowest in the group with deep vein incompetence (median 0.9, range 0–36.9), intermediate in the groups with superficial vein incompetence (median 7.6, range 0.4–59) and with incompetent perforating veins (median 14.6, range 0.4–35.7) and highest in the group with normal veins (median 41.7, range 3.5–87.5). The association of symptoms and VSI was also examined. The lower the VSI the more severe were the clinical symptoms and all ulcerated limbs had a VSI < 20. However a number of clinically normal limbs were also found to have low values of VSI.